Fondaparinux versus Enoxaparin in non-ST-elevation acute coronary syndromes: short-term cost and long-term cost-effectiveness using data from the Fifth Organization to Assess Strategies in Acute Ischemic Syndromes Investigators (OASIS-5) trial.
BACKGROUND
The study aimed to compare the short-term costs and long-term cost-effectiveness of 2 antithrombotics, fondaparinux and enoxaparin, for non-ST-elevation acute coronary syndrome in the United States.


METHODS
It was based on a large randomized trial of 20,078 patients Fifth Organization to Assess Strategies in Acute Ischemic Syndromes Investigators [OASIS-5] comparing the therapies in these patients. In OASIS-5, fondaparinux patients had about half the rate of major bleeding 9 days after randomization and at least as good clinical outcomes (death, myocardial infarction, major bleeding and stroke) after 6 months of follow-up. Health care resource use and clinical efficacy data from the trial were incorporated into a cost-effectiveness model as applied to a general US health care system both for the time horizon of the study (6 months) and over the longer term.


RESULTS
The 180-day cost analysis indicates that fondaparinux would generate a cost saving of $547 per patient (95% CI $207-$924). Sensitivity analysis suggested that savings could vary between $494 and $733. When 180-day cost and clinical results were extrapolated to long-term cost-effectiveness, fondaparinux was dominant (less costly and more effective in terms of quality-adjusted life-years) under most scenarios.


CONCLUSIONS
Fondaparinux is a more cost-effective antithrombotic agent than enoxaparin in non-ST-elevation acute coronary syndrome. This is true across the range of event risks seen in OASIS-5.
Centre for Health Economics, University of York, York, United Kingdom; Oxford Outcomes Ltd, Oxford, United Kingdom. mjs23@york.ac.uk
Mark J
MJ
Sculpher
Greta
G
Lozano-Ortega
Jennifer
J
Sambrook
Stephen
S
Palmer
Orges
O
Ormanidhi
Ameet
A
Bakhai
Marcus
M
Flather
P Gabriel
PG
Steg
Shamir R
SR
Mehta
William
W
Weintraub
D054058:Acute Coronary Syndrome / Q000188:drug therapy* / Q000191:economics; D000925:Anticoagulants / Q000191:economics / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis / Q000379:methods*; D004562:Electrocardiography; D017984:Enoxaparin / Q000191:economics / Q000627:therapeutic use*; D005170:Factor X; D005500:Follow-Up Studies; D000077425:Fondaparinux; D019983:Guideline Adherence; D017048:Health Care Costs / Q000639:trends*; D006801:Humans; D011134:Polysaccharides / Q000191:economics / Q000627:therapeutic use*; D017410:Practice Guidelines as Topic; D013997:Time Factors; D014481:United States
D000925:Anticoagulants; D017984:Enoxaparin; D011134:Polysaccharides; D005170:Factor X; D000077425:Fondaparinux