Cost effectiveness of enoxaparin in acute ST-segment elevation myocardial infarction: the ExTRACT-TIMI 25 (Enoxaparin and Thrombolysis Reperfusion for Acute Myocardial Infarction Treatment-Thrombolysis In Myocardial Infarction 25) study.
OBJECTIVE
We used a U.S. model of health care costs to examine the cost effectiveness of enoxaparin compared with unfractionated heparin (UFH) as adjunctive therapy for fibrinolysis in patients with ST-segment elevation myocardial infarction (STEMI).


BACKGROUND
The ExTRACT-TIMI 25 (Enoxaparin and Thrombolysis Reperfusion for Acute Myocardial Infarction Treatment-Thrombolysis In Myocardial Infarction 25) study, a large, randomized, multinational trial, demonstrated a reduction in death or nonfatal myocardial infarction when enoxaparin was used instead of UFH as adjunctive therapy for fibrinolysis in patients with STEMI.


METHODS
We used patient-level clinical outcomes and resource use from the ExTRACT-TIMI 25 trial and estimates of life expectancy gains as a result of the prevention of the clinical events on the basis of the Framingham Heart Study.


RESULTS
Index hospitalization costs trended lower by $126 in the enoxaparin group (95% confidence interval [CI]: -$295 to $49). Thirty-day costs trended higher by $102 for enoxaparin (95% CI: $108 to $314). Patients receiving enoxaparin gained an average of 0.12 life-years relative to patients given UFH. Estimated total lifetime costs were $1,207 higher in the enoxaparin group (95% CI: $491 to $1,923). The incremental cost-effectiveness ratio of enoxaparin compared with UFH was $5,700 per life-year gained, with 99.9% of bootstrap-derived estimates <$50,000 per life-year gained. Using a probabilistic sensitivity analysis, there is a 90% probability that enoxaparin is cost effective for lifetime, provided that the willingness-to-pay value exceeds $50,000.


CONCLUSIONS
Based on a U.S. model of health care economics, the strategy of using enoxaparin instead of UFH as adjunctive therapy for fibrinolysis in patients with STEMI is cost effective according to commonly used benchmarks.
Christiana Care Center for Outcomes Research, Christiana Care Health System, Newark, Delaware 19718, USA.
Leo
L
Marcoff
Zugui
Z
Zhang
Wei
W
Zhang
Edward
E
Ewen
Claudine
C
Jurkovitz
Prisca
P
Leguet
Paul
P
Kolm
William S
WS
Weintraub
D000368:Aged; D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis; D004311:Double-Blind Method; D017984:Enoxaparin / Q000191:economics* / Q000627:therapeutic use; D005260:Female; D005343:Fibrinolytic Agents / Q000191:economics* / Q000627:therapeutic use; D006493:Heparin / Q000191:economics / Q000627:therapeutic use; D006760:Hospitalization / Q000191:economics; D006801:Humans; D008017:Life Expectancy; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000401:mortality; D019057:Quality-Adjusted Life Years
D017984:Enoxaparin; D005343:Fibrinolytic Agents; D006493:Heparin