PMID- 35147675
OWN - NLM
STAT- MEDLINE
DCOM- 20220524
LR  - 20220716
IS  - 2473-9537 (Electronic)
IS  - 2473-9529 (Print)
IS  - 2473-9529 (Linking)
VI  - 6
IP  - 10
DP  - 2022 May 24
TI  - Cost-effectiveness analysis of alternative anticoagulation in suspected 
      heparin-induced thrombocytopenia.
PG  - 3114-3125
LID - 10.1182/bloodadvances.2022007017 [doi]
AB  - Heparin-induced thrombocytopenia (HIT) is a life-threatening complication 
      associated with high medical costs. Factor Xa inhibitors gradually replace 
      approved treatment with intravenous direct thrombin inhibitors despite their 
      off-label indication, because of easier management and favorable economic 
      profile. Whether they are cost-effective remains unclear. We evaluated the 
      cost-effectiveness of approved and off-label anticoagulants in patients with 
      suspected HIT, based on census data from the largest Swiss hospital between 2015 
      and 2018. We constructed a decision tree model that reflects important clinical 
      events associated with HIT. Relevant cost data were obtained from the finance 
      department or estimated based on the Swiss-wide cost tariff. We estimated averted 
      adverse events (AEs) and incremental cost-effectiveness ratio as primary outcome 
      parameters. We performed deterministic and probabilistic sensitivity analyses 
      with 2000 simulations to assess the robustness of our results. In the base-case 
      analysis, the total cost of averting 1 AE was 49 565 Swiss francs (CHF) for 
      argatroban, 30 380 CHF for fondaparinux, and 30 610 CHF for rivaroxaban; after 
      adjusting for 4Ts score: 41 152 CHF (argatroban), 27 710 CHF (fondaparinux), and 
      37 699 CHF (rivaroxaban). Fondaparinux and rivaroxaban were more clinically 
      effective than argatroban, with AEs averted of 0.820, 0.834, and 0.917 for 
      argatroban, fondaparinux, and rivaroxaban, respectively. Treatment with 
      fondaparinux resulted in less cost and more AEs averted, hence dominating 
      argatroban. Results were most sensitive to AE rates and prolongation of stay. 
      Monte Carlo simulations affirmed our base-case analysis. This is the first 
      cost-effectiveness analysis comparing argatroban with fondaparinux and 
      rivaroxaban using primary data. Fondaparinux and rivaroxaban resulted in more 
      averted AEs, but fondaparinux had greater cost savings. Fondaparinux could be a 
      viable alternative to argatroban.
CI  - (c) 2022 by The American Society of Hematology. Licensed under Creative Commons 
      Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0), 
      permitting only noncommercial, nonderivative use with attribution. All other 
      rights reserved.
FAU - Tuleja, Aleksandra
AU  - Tuleja A
AUID- ORCID: 0000-0002-7108-418X
AD  - Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University 
      Hospital, University of Bern, Bern, Switzerland.
AD  - Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, 
      Switzerland.
AD  - Graduate School for Health Sciences, University of Bern, Bern, Switzerland.
FAU - Salvador, Dante
AU  - Salvador D
AUID- ORCID: 0000-0002-4738-5628
AD  - Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, 
      Switzerland.
AD  - Graduate School for Health Sciences, University of Bern, Bern, Switzerland.
AD  - Department of Cardiology, Inselspital, Bern University Hospital, University of 
      Bern, Bern, Switzerland; and.
FAU - Muka, Taulant
AU  - Muka T
AUID- ORCID: 0000-0003-3235-3073
AD  - Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, 
      Switzerland.
FAU - Bernhard, Sarah
AU  - Bernhard S
AUID- ORCID: 0000-0002-2750-5928
AD  - Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University 
      Hospital, University of Bern, Bern, Switzerland.
FAU - Lenz, Armando
AU  - Lenz A
AUID- ORCID: 0000-0001-5888-0846
AD  - Clinical Trials Unit, University of Bern, Bern, Switzerland.
FAU - Baumgartner, Iris
AU  - Baumgartner I
AD  - Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University 
      Hospital, University of Bern, Bern, Switzerland.
FAU - Schindewolf, Marc
AU  - Schindewolf M
AUID- ORCID: 0000-0003-4597-0759
AD  - Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University 
      Hospital, University of Bern, Bern, Switzerland.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Blood Adv
JT  - Blood advances
JID - 101698425
RN  - 0 (Anticoagulants)
RN  - 9005-49-6 (Heparin)
RN  - 9NDF7JZ4M3 (Rivaroxaban)
RN  - J177FOW5JL (Fondaparinux)
SB  - IM
MH  - Anticoagulants/adverse effects
MH  - Cost-Benefit Analysis
MH  - Fondaparinux/therapeutic use
MH  - *Heparin/adverse effects
MH  - Humans
MH  - Rivaroxaban/therapeutic use
MH  - *Thrombocytopenia/chemically induced/drug therapy
PMC - PMC9131923
EDAT- 2022/02/12 06:00
MHDA- 2022/05/25 06:00
PMCR- 2022/05/20
CRDT- 2022/02/11 12:12
PHST- 2022/01/10 00:00 [received]
PHST- 2022/02/08 00:00 [accepted]
PHST- 2022/02/12 06:00 [pubmed]
PHST- 2022/05/25 06:00 [medline]
PHST- 2022/02/11 12:12 [entrez]
PHST- 2022/05/20 00:00 [pmc-release]
AID - 483982 [pii]
AID - 2022/ADV2022007017 [pii]
AID - 10.1182/bloodadvances.2022007017 [doi]
PST - ppublish
SO  - Blood Adv. 2022 May 24;6(10):3114-3125. doi: 10.1182/bloodadvances.2022007017.