PMID- 14594436
OWN - NLM
STAT- MEDLINE
DCOM- 20040112
LR  - 20181113
IS  - 1170-7690 (Print)
IS  - 1170-7690 (Linking)
VI  - 21
IP  - 16
DP  - 2003
TI  - Costs and cost effectiveness of low molecular weight heparins and platelet 
      glycoprotein IIb/IIIa inhibitors: in the management of acute coronary syndromes.
PG  - 1135-52
AB  - The most well established antithrombotic treatment for acute coronary syndromes 
      (ACS) is unfractionated heparin (UFH) plus aspirin, but such treatment may not 
      prevent arterial thrombotic events. Low molecular weight heparins (LMWHs) and 
      platelet glycoprotein (GP) IIb/IIIa inhibitors offer alternative or adjunctive 
      treatments. However, before these alternatives with higher acquisition costs are 
      accepted in today's healthcare systems, their cost effectiveness must be proven. 
      This paper reviews international pharmacoeconomic studies on the use of LMWHs and 
      GP IIb/IIIa inhibitors in patients with ACS in an attempt to determine whether 
      these therapies are cost effective. Most of the studies on LMWHs have been 
      cost-minimisation analyses and have focused on enoxaparin sodium, because this is 
      the only LMWH proven to be superior to UFH. Several analyses show that, compared 
      with UFH plus aspirin, enoxaparin sodium provides cost savings both during 
      hospitalisation (30 days) and 1-year follow-up. These cost savings are mainly 
      attributable to fewer cardiac interventions, shorter hospital stays and lower 
      administrative costs. Indeed, the clinical and economic advantages of enoxaparin 
      sodium have led to its recommendation in recent guidelines as the antithrombotic 
      agent of choice for coronary artery disease. Most of the economic analyses of GP 
      IIb/IIIa inhibitors have been cost-effectiveness analyses. Such analyses indicate 
      that the high acquisition costs of these drugs may be at least partially offset 
      by reductions in other costs if a noninvasive approach to risk stratification is 
      used. Furthermore, use of GP IIb/IIIa inhibitors appears to give favourable 
      cost-effectiveness ratios compared with other accepted therapies, such as 
      fibrin-specific thrombolytic therapy, in the cardiovascular field, particularly 
      in high-risk patients and those undergoing percutaneous coronary intervention. 
      However, more comprehensive economic data on the GP IIb/IIIa inhibitors are 
      needed.
FAU - Bosanquet, Nick
AU  - Bosanquet N
AD  - Department of Bioengineering, Imperial College School of Science, Technology and 
      Medicine, London, UK.
FAU - Jonsson, Bengt
AU  - Jonsson B
FAU - Fox, Keith A A
AU  - Fox KA
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PT  - Review
PL  - New Zealand
TA  - Pharmacoeconomics
JT  - PharmacoEconomics
JID - 9212404
RN  - 0 (Enoxaparin)
RN  - 0 (Fibrinolytic Agents)
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 0 (Platelet Glycoprotein GPIIb-IIIa Complex)
MH  - Acute Disease
MH  - Angina, Unstable/drug therapy/therapy
MH  - Angioplasty, Balloon, Coronary/adverse effects
MH  - Clinical Trials as Topic
MH  - Coronary Disease/*drug therapy/therapy
MH  - Coronary Restenosis/etiology/prevention & control
MH  - Costs and Cost Analysis
MH  - Enoxaparin/adverse effects/economics/therapeutic use
MH  - Fibrinolytic Agents/adverse effects/*economics/therapeutic use
MH  - Heparin, Low-Molecular-Weight/adverse effects/*economics/therapeutic use
MH  - Humans
MH  - Myocardial Infarction/drug therapy/therapy
MH  - Platelet Glycoprotein GPIIb-IIIa Complex/*antagonists & inhibitors
MH  - Thrombosis/etiology/prevention & control
RF  - 67
EDAT- 2003/11/05 05:00
MHDA- 2004/01/13 05:00
CRDT- 2003/11/05 05:00
PHST- 2003/11/05 05:00 [pubmed]
PHST- 2004/01/13 05:00 [medline]
PHST- 2003/11/05 05:00 [entrez]
AID - 21161 [pii]
AID - 10.2165/00019053-200321160-00001 [doi]
PST - ppublish
SO  - Pharmacoeconomics. 2003;21(16):1135-52. doi: 10.2165/00019053-200321160-00001.