PMID- 18237596
OWN - NLM
STAT- MEDLINE
DCOM- 20080312
LR  - 20181201
IS  - 0002-9149 (Print)
IS  - 0002-9149 (Linking)
VI  - 101
IP  - 3
DP  - 2008 Feb 1
TI  - Cost in the use of enoxaparin compared with unfractionated heparin in patients 
      with atrial fibrillation undergoing a transesophageal echocardiography-guided 
      cardioversion (from Assessment of Cardioversion using Transesophageal 
      Echocardiography [ACUTE] II randomized multicenter study).
PG  - 338-42
LID - 10.1016/j.amjcard.2007.09.075 [doi]
AB  - The ACUTE II study demonstrated that transesophageal echocardiographically guided 
      cardioversion with enoxaparin in patients with atrial fibrillation was associated 
      with shorter initial hospital stay, more normal sinus rhythm at 5 weeks, and no 
      significant differences in stroke, bleeding, or death compared with 
      unfractionated heparin (UFH). The present study evaluated resource use and costs 
      in enoxaparin (n=76) and UFH (n=79) during 5-week follow-up. Resources included 
      initial and subsequent hospitalizations, study drugs, outpatient services, and 
      emergency room visits. Two costing approaches were employed for the 
      hospitalization costing. The first approach was based on the UB-92 formulation of 
      hospital bill and diagnosis-related group. The second approach was based on UB-92 
      and imputation using multivariable linear regression. Costs for outpatient and 
      emergency room visits were determined from the Medicare fee schedule. Sensitivity 
      analysis was performed to assess the robustness of the results. A bootstrap 
      resample approach was used to obtain the confidence interval (CI) for the cost 
      differences. Costs of initial and subsequent hospitalizations, outpatient 
      procedures, and emergency room visits were lower in the enoxaparin group. Average 
      total costs remained significantly lower for the enoxaparin group for the 2 
      costing approaches ($5,800 vs $8,167, difference $2,367, 95% CI 855 to 4,388, for 
      the first approach; $7,942 vs $10,076, difference $2,134, 95% CI 437 to 4,207, 
      for the second approach). Sensitivity analysis showed that cost differences 
      between strategies are robust to variation of drug costs. In conclusion, the use 
      of enoxaparin as a bridging therapy is a cost-saving strategy (similar clinical 
      outcomes and lower costs) for atrial fibrillation.
FAU - Zhao, Liping
AU  - Zhao L
AD  - Emory University, Atlanta, Georgia, USA. lzhao2@emory.edu
FAU - Zhang, Zefeng
AU  - Zhang Z
FAU - Kolm, Paul
AU  - Kolm P
FAU - Jasper, Susan
AU  - Jasper S
FAU - Lewis, Cheryl
AU  - Lewis C
FAU - Klein, Allan
AU  - Klein A
FAU - Weintraub, William
AU  - Weintraub W
CN  - ACUTE II Investigators
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Am J Cardiol
JT  - The American journal of cardiology
JID - 0207277
RN  - 0 (Enoxaparin)
RN  - 0 (Fibrinolytic Agents)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Aged
MH  - Atrial Fibrillation/*economics/therapy
MH  - Costs and Cost Analysis
MH  - Echocardiography, Transesophageal
MH  - *Electric Countershock
MH  - Enoxaparin/*economics/therapeutic use
MH  - Female
MH  - Fibrinolytic Agents/*economics/therapeutic use
MH  - Health Services/statistics & numerical data
MH  - Heparin/*economics/therapeutic use
MH  - Hospital Costs/*statistics & numerical data
MH  - Humans
MH  - Male
MH  - Medicare/economics
MH  - Middle Aged
MH  - Research Design
MH  - Ultrasonography, Interventional
MH  - United States
EDAT- 2008/02/02 09:00
MHDA- 2008/03/13 09:00
CRDT- 2008/02/02 09:00
PHST- 2007/06/25 00:00 [received]
PHST- 2007/09/04 00:00 [revised]
PHST- 2007/09/04 00:00 [accepted]
PHST- 2008/02/02 09:00 [pubmed]
PHST- 2008/03/13 09:00 [medline]
PHST- 2008/02/02 09:00 [entrez]
AID - S0002-9149(07)01905-4 [pii]
AID - 10.1016/j.amjcard.2007.09.075 [doi]
PST - ppublish
SO  - Am J Cardiol. 2008 Feb 1;101(3):338-42. doi: 10.1016/j.amjcard.2007.09.075.