Minimizing costs for treating deep vein thrombosis: the role for fondaparinux.
BACKGROUND
Deep vein thrombosis (DVT) remains a major burden and fondaparinux represents a new option for DVT therapy. We sought to determine if fondaparinux offered financial advantages over low-molecular weight heparin since it is given as a fixed dose over a wide range of patient weights rather then dosed directly on weight and because fondaparinux is not associated with heparin-induced thrombocytopenia (HIT).


METHODS
We conducted a cost-minimization analysis comparing fondaparinux to enoxaparin for acute anticoagulation in DVT. We modeled a cohort of 1,000 hypothetical subjects and drew estimates for model inputs from the published literature. We completed multiple sensitivity analyses to asses the significance of our assumptions and used Monte Carlo simulation to estimate the 95% confidence intervals (CIs) around our estimation of the cost differential for the two agents.


RESULTS
In the base case, total disease management costs per patient with fondaparinux are US 472 dollars compared to 769 dollars with enoxaparin. The 95% CI around this difference ranges from US 48 dollars to US 401 dollars. The model was mildly sensitive to the pharmacy acquisition costs of fondaparinux and enoxaparin which was the major driver of overall costs. Neither the rates of nor costs associated with DVT recurrence, major bleeding, nor HIT substantially affected our observations. Breakeven analysis indicated our findings to be robust over a wide range of likely clinical scenarios.


CONCLUSIONS
From the perspective of a healthcare system, fondaparinux use offers an attractive economic alternative to other agents for initial DVT therapy. Expanded reliance on fondaparinux could potentially result in savings.
Shorr
Andrew F
AF
Pulmonary and Critical Care Medicine, Washington Hospital Center, 110 Irving St., NW, Washington, DC 20010, USA. afshorr@dnamail.com
Jackson
William L
WL
Moores
Lisa K
LK
Warkentin
Theodore E
TE
D001835:Body Weight; D003365:Costs and Cost Analysis; D017984:Enoxaparin / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D000077425:Fondaparinux; D006470:Hemorrhage; D006495:Heparin, Low-Molecular-Weight / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D006801:Humans; D018803:Models, Economic; D011134:Polysaccharides / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use; D012008:Recurrence; D013927:Thrombosis / Q000139:chemically induced; D020246:Venous Thrombosis / Q000188:drug therapy* / Q000191:economics*
D017984:Enoxaparin; D006495:Heparin, Low-Molecular-Weight; D011134:Polysaccharides; D000077425:Fondaparinux