Cost effectiveness of fondaparinux in non-ST-elevation acute coronary syndrome.
BACKGROUND
Fondaparinux has been shown to reduce the risk of major bleeding and 30-day mortality compared with enoxaparin, in patients with non-ST-elevation acute coronary syndrome (NSTE-ACS). However, its cost effectiveness is not well known.


OBJECTIVE
To evaluate the effectiveness and economic attractiveness of fondaparinux relative to enoxaparin in patients with NSTE-ACS treated with triple antiplatelet therapy and early (non-urgent) invasive strategy.


METHODS
The decision model compares two alternative strategies: subcutaneous (SC) enoxaparin (1 mg/kg 12 hourly) versus SC fondaparinux (2.5 mg/day) in NSTE-ACS patients pre-treated with triple antiplatelet therapy and early revascularization. Cost-effectiveness and cost-utility analyses were performed from a healthcare perspective, based on a Markov model with a time horizon of the patient lifespan. Univariate sensitivity analysis and probabilistic (Monte Carlo) microsimulation analysis were performed.


RESULTS
In the base-case analysis (65 years, Thrombolysis In Myocardial Infarction [TIMI] score 4), the use of fondaparinux was associated with a significant reduction in major bleeding, a slight reduction in adverse cardiac events, and minor improvements in survival and QALYs, together with a small reduction in costs. The dominance of fondaparinux over enoxaparin remained unchanged in the univariate sensitivity analyses. According to Monte Carlo simulation, fondaparinux was cost saving in 99.9% of cases.


CONCLUSIONS
Compared with enoxaparin, the use of fondaparinux in patients with NSTE-ACS managed with an early invasive strategy appears to be cost effective, even in patients with a low risk of bleeding.
Latour-Perez
Jaime
J
Intensive Care and Coronary Unit, Hospital General Universitario de Elche, Elche, Spain. jlatour@coma.es
de-Miguel-Balsa
Eva
E
D054058:Acute Coronary Syndrome / Q000188:drug therapy* / Q000191:economics; D000925:Anticoagulants / Q000191:economics* / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D003627:Data Interpretation, Statistical; D003661:Decision Support Techniques; D004562:Electrocardiography; D000077425:Fondaparinux; D006801:Humans; D008390:Markov Chains; D011134:Polysaccharides / Q000191:economics* / Q000627:therapeutic use*
D000925:Anticoagulants; D011134:Polysaccharides; D000077425:Fondaparinux