PMID- 22058011
OWN - NLM
STAT- MEDLINE
DCOM- 20120621
LR  - 20220310
IS  - 1553-5606 (Electronic)
IS  - 1553-5592 (Linking)
VI  - 7
IP  - 3
DP  - 2012 Mar
TI  - Economic impact of enoxaparin versus unfractionated heparin for venous 
      thromboembolism prophylaxis in patients with acute ischemic stroke: a hospital 
      perspective of the PREVAIL trial.
PG  - 176-82
LID - 10.1002/jhm.968 [doi]
AB  - BACKGROUND: The PREVAIL (Prevention of VTE [venous thromboembolism] after acute 
      ischemic stroke with LMWH [low-molecular-weight heparin] and UFH [unfractionated 
      heparin]) study demonstrated a 43% VTE risk reduction with enoxaparin versus UFH 
      in patients with acute ischemic stroke (AIS). A 1% rate of symptomatic 
      intracranial and major extracranial hemorrhage was observed in both groups. 
      OBJECTIVE: To determine the economic impact, from a hospital perspective, of 
      enoxaparin versus UFH for VTE prophylaxis after AIS. DESIGN: A decision-analytic 
      model was constructed and hospital-based costs analyzed using clinical 
      information from PREVAIL. Total hospital costs were calculated based on mean 
      costs in the Premier database and from wholesalers acquisition data. Costs were 
      also compared in patients with severe stroke (National Institutes of Health 
      Stroke Scale [NIHSS] score >/=14) and less severe stroke (NIHSS score <14). 
      RESULTS: The average cost per patient due to VTE or bleeding events was lower 
      with enoxaparin versus UFH ($422 vs $662, respectively; net savings $240). The 
      average anticoagulant cost, including drug-administration cost per patient, was 
      lower with UFH versus enoxaparin ($259 vs $360, respectively; net savings $101). 
      However, when both clinical events and drug-acquisition costs were considered, 
      the total hospital cost was lower with enoxaparin versus UFH ($782 vs $922, 
      respectively; savings $140). Hospital cost-savings were greatest ($287) in 
      patients with NIHSS scores >/=14. CONCLUSIONS: The higher drug cost of enoxaparin 
      was offset by the reduction in clinical events as compared to the use of UFH for 
      VTE prophylaxis after an AIS, particularly in patients with severe stroke.
CI  - Copyright (c) 2011 Society of Hospital Medicine.
FAU - Pineo, Graham
AU  - Pineo G
AD  - Department of Medicine, University of Calgary, Calgary, Canada. 
      graham.pineo@albertahealthservices.ca
FAU - Lin, Jay
AU  - Lin J
FAU - Stern, Lee
AU  - Stern L
FAU - Subrahmanian, Tarun
AU  - Subrahmanian T
FAU - Annemans, Lieven
AU  - Annemans L
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20111104
PL  - United States
TA  - J Hosp Med
JT  - Journal of hospital medicine
JID - 101271025
RN  - 0 (Anticoagulants)
RN  - 0 (Enoxaparin)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Acute Disease
MH  - Anticoagulants/administration & dosage/adverse effects/*economics
MH  - Cost Savings
MH  - Cost-Benefit Analysis
MH  - Databases, Factual
MH  - Decision Support Techniques
MH  - Enoxaparin/administration & dosage/adverse effects/*economics
MH  - Heparin/administration & dosage/adverse effects/*economics
MH  - Hospital Costs
MH  - Humans
MH  - Outcome Assessment, Health Care/methods
MH  - Stroke/*complications/drug therapy
MH  - United States
MH  - Venous Thromboembolism/etiology/*prevention & control
EDAT- 2011/11/08 06:00
MHDA- 2012/06/22 06:00
CRDT- 2011/11/08 06:00
PHST- 2010/09/14 00:00 [received]
PHST- 2011/05/23 00:00 [revised]
PHST- 2011/07/17 00:00 [accepted]
PHST- 2011/11/08 06:00 [entrez]
PHST- 2011/11/08 06:00 [pubmed]
PHST- 2012/06/22 06:00 [medline]
AID - 10.1002/jhm.968 [doi]
PST - ppublish
SO  - J Hosp Med. 2012 Mar;7(3):176-82. doi: 10.1002/jhm.968. Epub 2011 Nov 4.