PMID- 19778669
OWN - NLM
STAT- MEDLINE
DCOM- 20091110
LR  - 20090925
IS  - 1558-3597 (Electronic)
IS  - 0735-1097 (Linking)
VI  - 54
IP  - 14
DP  - 2009 Sep 29
TI  - Cost effectiveness of enoxaparin in acute ST-segment elevation myocardial 
      infarction: the ExTRACT-TIMI 25 (Enoxaparin and Thrombolysis Reperfusion for 
      Acute Myocardial Infarction Treatment-Thrombolysis In Myocardial Infarction 25) 
      study.
PG  - 1271-9
LID - 10.1016/j.jacc.2009.05.060 [doi]
AB  - OBJECTIVES: We used a U.S. model of health care costs to examine the cost 
      effectiveness of enoxaparin compared with unfractionated heparin (UFH) as 
      adjunctive therapy for fibrinolysis in patients with ST-segment elevation 
      myocardial infarction (STEMI). BACKGROUND: The ExTRACT-TIMI 25 (Enoxaparin and 
      Thrombolysis Reperfusion for Acute Myocardial Infarction Treatment-Thrombolysis 
      In Myocardial Infarction 25) study, a large, randomized, multinational trial, 
      demonstrated a reduction in death or nonfatal myocardial infarction when 
      enoxaparin was used instead of UFH as adjunctive therapy for fibrinolysis in 
      patients with STEMI. METHODS: We used patient-level clinical outcomes and 
      resource use from the ExTRACT-TIMI 25 trial and estimates of life expectancy 
      gains as a result of the prevention of the clinical events on the basis of the 
      Framingham Heart Study. RESULTS: Index hospitalization costs trended lower by 
      $126 in the enoxaparin group (95% confidence interval [CI]: -$295 to $49). 
      Thirty-day costs trended higher by $102 for enoxaparin (95% CI: $108 to $314). 
      Patients receiving enoxaparin gained an average of 0.12 life-years relative to 
      patients given UFH. Estimated total lifetime costs were $1,207 higher in the 
      enoxaparin group (95% CI: $491 to $1,923). The incremental cost-effectiveness 
      ratio of enoxaparin compared with UFH was $5,700 per life-year gained, with 99.9% 
      of bootstrap-derived estimates <$50,000 per life-year gained. Using a 
      probabilistic sensitivity analysis, there is a 90% probability that enoxaparin is 
      cost effective for lifetime, provided that the willingness-to-pay value exceeds 
      $50,000. CONCLUSIONS: Based on a U.S. model of health care economics, the 
      strategy of using enoxaparin instead of UFH as adjunctive therapy for 
      fibrinolysis in patients with STEMI is cost effective according to commonly used 
      benchmarks.
FAU - Marcoff, Leo
AU  - Marcoff L
AD  - Christiana Care Center for Outcomes Research, Christiana Care Health System, 
      Newark, Delaware 19718, USA.
FAU - Zhang, Zugui
AU  - Zhang Z
FAU - Zhang, Wei
AU  - Zhang W
FAU - Ewen, Edward
AU  - Ewen E
FAU - Jurkovitz, Claudine
AU  - Jurkovitz C
FAU - Leguet, Prisca
AU  - Leguet P
FAU - Kolm, Paul
AU  - Kolm P
FAU - Weintraub, William S
AU  - Weintraub WS
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - J Am Coll Cardiol
JT  - Journal of the American College of Cardiology
JID - 8301365
RN  - 0 (Enoxaparin)
RN  - 0 (Fibrinolytic Agents)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - Cost-Benefit Analysis
MH  - Double-Blind Method
MH  - Enoxaparin/*economics/therapeutic use
MH  - Female
MH  - Fibrinolytic Agents/*economics/therapeutic use
MH  - Heparin/economics/therapeutic use
MH  - Hospitalization/economics
MH  - Humans
MH  - Life Expectancy
MH  - Male
MH  - Middle Aged
MH  - Models, Economic
MH  - Myocardial Infarction/*drug therapy/mortality
MH  - Quality-Adjusted Life Years
EDAT- 2009/09/26 06:00
MHDA- 2009/11/11 06:00
CRDT- 2009/09/26 06:00
PHST- 2009/03/17 00:00 [received]
PHST- 2009/05/13 00:00 [accepted]
PHST- 2009/09/26 06:00 [entrez]
PHST- 2009/09/26 06:00 [pubmed]
PHST- 2009/11/11 06:00 [medline]
AID - S0735-1097(09)02246-3 [pii]
AID - 10.1016/j.jacc.2009.05.060 [doi]
PST - ppublish
SO  - J Am Coll Cardiol. 2009 Sep 29;54(14):1271-9. doi: 10.1016/j.jacc.2009.05.060.