PMID- 20422473
OWN - NLM
STAT- MEDLINE
DCOM- 20100817
LR  - 20100513
IS  - 1865-8652 (Electronic)
IS  - 0741-238X (Linking)
VI  - 27
IP  - 3
DP  - 2010 Mar
TI  - Enoxaparin is a cost-effective adjunct to fibrinolytic therapy for ST-elevation 
      myocardial infarction in contemporary practice.
PG  - 181-91
LID - 10.1007/s12325-010-0013-x [doi]
AB  - INTRODUCTION: In patients receiving fibrinolytic therapy for ST-elevation 
      myocardial infarction (STEMI), adjunct treatment with enoxaparin has been shown 
      to provide superior net clinical benefit compared with unfractionated heparin 
      (UFH) in the Enoxaparin and Thrombolysis Reperfusion for Acute Myocardial 
      Infarction Treatment - Thrombolysis in Myocardial Infarction (ExTRACT-TIMI) 25 
      study. The objective of this study was to compare the cost effectiveness of 
      enoxaparin and UFH strategies. METHODS: A cost-utility analysis was conducted 
      using a two-stage model: (1) A 30-day decision tree analytical model for the 
      acute treatment phase, and (2) a lifetime Markov model (from 30 days post-STEMI 
      until death) populated using patient survival data. RESULTS: Assuming treatment 
      continuation for 7 days, the mean day 1-30 incremental cost associated with 
      enoxaparin was pound 49 per patient, and mean lifetime incremental cost was pound 
      592 per patient ( pound 91,091 vs. pound 90,499, respectively). Given an 
      additional 0.048 life years gained per patient with enoxaparin, the cost per life 
      year saved was pound 12,353, and given an additional 0.038 quality-adjusted life 
      years (QALY) per patient with enoxaparin, the cost per QALY was pound 15,413. In 
      an alternative scenario, reflecting contemporary practice assuming early 
      treatment discontinuation at 48 hours, for example following urgent 
      revascularization, the incremental cost per QALY was pound 13,556. CONCLUSION: 
      The use of an enoxaparin versus UFH strategy in patients receiving fibrinolytic 
      therapy for STEMI, whether continued for 7 days or discontinued early, for 
      example following urgent revascularization, is cost effective at a pound 20,000 
      willingness-to-pay threshold.
FAU - Menown, Ian
AU  - Menown I
AD  - Craigavon Cardiac Centre, Craigavon, Northern Ireland, UK. 
      ian.menown@southerntrust.hscni.net
FAU - Montalescot, Gilles
AU  - Montalescot G
FAU - Pal, Nikhal
AU  - Pal N
FAU - Fidler, Carrie
AU  - Fidler C
FAU - Orme, Michelle
AU  - Orme M
FAU - Gillard, Samantha
AU  - Gillard S
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20100423
PL  - United States
TA  - Adv Ther
JT  - Advances in therapy
JID - 8611864
RN  - 0 (Enoxaparin)
RN  - 0 (Fibrinolytic Agents)
RN  - 9005-49-6 (Heparin)
MH  - Cost-Benefit Analysis
MH  - Decision Trees
MH  - Electrocardiography
MH  - Enoxaparin/*economics/therapeutic use
MH  - Fibrinolytic Agents/*economics/therapeutic use
MH  - Heparin/*economics/therapeutic use
MH  - Humans
MH  - Markov Chains
MH  - Myocardial Infarction/*drug therapy
MH  - Quality-Adjusted Life Years
EDAT- 2010/04/28 06:00
MHDA- 2010/08/18 06:00
CRDT- 2010/04/28 06:00
PHST- 2010/02/19 00:00 [received]
PHST- 2010/04/28 06:00 [entrez]
PHST- 2010/04/28 06:00 [pubmed]
PHST- 2010/08/18 06:00 [medline]
AID - 10.1007/s12325-010-0013-x [doi]
PST - ppublish
SO  - Adv Ther. 2010 Mar;27(3):181-91. doi: 10.1007/s12325-010-0013-x. Epub 2010 Apr 
      23.