PMID- 10662478
OWN - NLM
STAT- MEDLINE
DCOM- 20000124
LR  - 20220330
IS  - 1170-7690 (Print)
IS  - 1170-7690 (Linking)
VI  - 16
IP  - 5 Pt 2
DP  - 1999 Nov
TI  - Cost-effectiveness analysis of enoxaparin versus unfractionated heparin for acute 
      coronary syndromes. A Canadian hospital perspective.
PG  - 533-42
AB  - OBJECTIVE: To determine the cost effectiveness of enoxaparin therapy versus 
      unfractionated heparin (UFH) therapy for patients with unstable coronary artery 
      disease from the perspective of a Canadian hospital. DESIGN: A predictive 
      decision analysis model using published clinical and economic evaluations and 
      costs of medical care in Canada. PATIENTS: A hypothetical cohort of patients 
      presenting to hospital with unstable angina or non-Q-wave myocardial infarction 
      as defined by the Efficacy and Safety of Subcutaneous Enoxaparin in Non-Q-Wave 
      Coronary Events (ESSENCE) trial. INTERVENTIONS: Two antithrombotic treatment 
      strategies were compared: (i) enoxaparin 1 mg/kg subcutaneously every 12 hours, 
      and (ii) UFH intravenous bolus and constant infusion adjusted to maintain a 
      therapeutic activated partial thromboplastin time. Both treatment strategies 
      included 100 to 325 mg of oral aspirin daily. Enoxaparin or UFH was continued for 
      a minimum of 48 hours to a maximum of 8 days. Cumulative outcomes were considered 
      up to 30 days after initial presentation to hospital. RESULTS: At 30 days, 19.8% 
      of patients who received enoxaparin compared with 23.3% of patients who received 
      UFH reached one of the primary composite events. There was no difference in major 
      bleeding between the 2 treatment groups (6.5% enoxaparin vs 6.8% UFH). The 
      average total direct medical cost per patient was $Can848 with the enoxaparin 
      strategy versus $Can892 with the UFH strategy (1999 values). Therapy with 
      enoxaparin was, therefore, considered to be the dominant strategy. Univariate 
      sensitivity analysis indicated that the decision model was not robust to changes 
      in the 30-day composite end-point, probability of recurrent angina, or base costs 
      for treatment of recurrent angina or enoxaparin therapy. CONCLUSION: Enoxaparin 
      is the dominant antithrombotic pharmacotherapeutic strategy for patients with 
      unstable coronary artery disease.
FAU - Balen, R M
AU  - Balen RM
AD  - University of British Columbia, Vancouver General Hospital, Canada.
FAU - Marra, C A
AU  - Marra CA
FAU - Zed, P J
AU  - Zed PJ
FAU - Cohen, M
AU  - Cohen M
FAU - Frighetto, L
AU  - Frighetto L
LA  - eng
PT  - Clinical Trial
PT  - Comparative Study
PT  - Journal Article
PL  - New Zealand
TA  - Pharmacoeconomics
JT  - PharmacoEconomics
JID - 9212404
RN  - 0 (Anticoagulants)
RN  - 0 (Enoxaparin)
RN  - 9005-49-6 (Heparin)
MH  - Acute Disease
MH  - Anticoagulants/*economics/*therapeutic use
MH  - Canada
MH  - Coronary Disease/*drug therapy/*economics/mortality
MH  - Cost-Benefit Analysis
MH  - Decision Support Techniques
MH  - Enoxaparin/*economics/*therapeutic use
MH  - Heparin/*economics/*therapeutic use
MH  - Hospitals
MH  - Humans
EDAT- 2000/02/08 00:00
MHDA- 2000/02/08 00:01
CRDT- 2000/02/08 00:00
PHST- 2000/02/08 00:00 [pubmed]
PHST- 2000/02/08 00:01 [medline]
PHST- 2000/02/08 00:00 [entrez]
AID - 10.2165/00019053-199916050-00009 [doi]
PST - ppublish
SO  - Pharmacoeconomics. 1999 Nov;16(5 Pt 2):533-42. doi: 
      10.2165/00019053-199916050-00009.