PMID- 12828495
OWN - NLM
STAT- MEDLINE
DCOM- 20030924
LR  - 20220330
IS  - 1170-7690 (Print)
IS  - 1170-7690 (Linking)
VI  - 21
IP  - 10
DP  - 2003
TI  - Cost-effectiveness analysis of enoxaparin versus unfractionated heparin in 
      patients with acute coronary syndrome in Poland: modelling study from the 
      hospital perspective.
PG  - 737-48
AB  - AIM AND PERSPECTIVE: To estimate the cost effectiveness of enoxaparin versus 
      unfractionated heparin (UFH) in patients with acute coronary syndrome (ACS) from 
      a Polish hospital perspective. This was intended to facilitate the decisionmaking 
      process in selecting the most cost-effective treatment for ACS. METHOD: A 
      decision model was used to quantify costs and effectiveness of alternative 
      treatments. Published results from the Efficacy and Safety of Subcutaneous 
      Enoxaparin in Non-Q-Wave Coronary Events (ESSENCE) study were used to estimate 
      the probability for clinical endpoints (death, myocardial infarction or recurrent 
      angina) at 30 days. Probabilities of patients undergoing revascularisation 
      procedures were obtained from the Global Registry of Acute Coronary Events 
      (GRACE) which included data from 961 patients at six centres in Poland. The 
      analysis assessed only direct medical costs, determined from actual resource 
      consumption on a patient-specific basis (6-month observational study) and 
      estimated using Polish data on unit costs. One- and two-way sensitivity analyses 
      and threshold analysis were performed. RESULTS: At 30 days, 19.8% of patients 
      receiving enoxaparin compared with 23.3% of those receiving UFH reached a 
      composite endpoint consisting of death, myocardial infarction and recurrent 
      angina (p = 0.02). The average costs (in zloty ; 1 US dollar = 4 zloty [2000 
      values]) were 1,085 per patient receiving enoxaparin compared with 1,097 per 
      patient receiving UFH. Therefore, for every 29 patients treated, not only would 
      enoxaparin therapy avoid one event of the composite endpoint, it would also save 
      348 zloty. The threshold analysis suggests that enoxaparin would lose dominance 
      when the cost of enoxaparin increased by 10%, the cost of monitoring UFH therapy 
      decreased by 12%, the probability of reaching the composite endpoint in the 
      enoxaparin arm increased to 0.22 or decreased to 0.21 in the UFH arm. CONCLUSION: 
      According to our model enoxaparin was more effective at a lower cost than UFH, 
      therefore this treatment was shown to be dominant for patients with ACS in 
      Poland.
FAU - Orlewska, Ewa
AU  - Orlewska E
AD  - Department of Experimental and Clinical Pharmacology, Medical University of 
      Warsaw, Warsaw, Poland. ewaorlewska@go2.pl
FAU - Budaj, Andrzej
AU  - Budaj A
FAU - Tereszkowski-Kaminski, Dariusz
AU  - Tereszkowski-Kaminski D
LA  - eng
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/economics
MH  - Aged
MH  - Aged, 80 and over
MH  - Anticoagulants/*economics/therapeutic use
MH  - Coronary Disease/*drug therapy/*economics
MH  - Cost-Benefit Analysis
MH  - Drug Costs/statistics & numerical data
MH  - Enoxaparin/*economics/therapeutic use
MH  - Female
MH  - Heparin/*economics/therapeutic use
MH  - Hospital Costs/*statistics & numerical data
MH  - Humans
MH  - Male
MH  - *Models, Statistical
MH  - Poland
EDAT- 2003/06/28 05:00
MHDA- 2003/09/25 05:00
CRDT- 2003/06/28 05:00
PHST- 2003/06/28 05:00 [pubmed]
PHST- 2003/09/25 05:00 [medline]
PHST- 2003/06/28 05:00 [entrez]
AID - 21105 [pii]
AID - 10.2165/00019053-200321100-00005 [doi]
PST - ppublish
SO  - Pharmacoeconomics. 2003;21(10):737-48. doi: 10.2165/00019053-200321100-00005.