Cost-effectiveness of enoxaparin compared with unfractionated heparin in ST elevation myocardial infarction patients undergoing pharmacological reperfusion: a Canadian analysis of the Enoxaparin and Thrombolysis Reperfusion for Acute Myocardial Infarction Treatment - Thrombolysis in Myocardial Infarction (ExTRACT-TIMI) 25 trial.
OBJECTIVE
To evaluate the cost-effectiveness of enoxaparin versus unfractionated heparin in conjunction with fibrinolysis in ST elevation myocardial infarction patients within Canada.


METHODS
Based on the Enoxaparin and Thrombolysis Reperfusion for Acute Myocardial Infarction Treatment - Thrombolysis in Myocardial Infarction (ExTRACT-TIMI) 25 trial, a model was created to analyze the cost-effectiveness of enoxaparin compared with unfractionated heparin in conjunction with fibrinolysis among ST elevation myocardial infarction patients within Canada. Clinical outcomes were derived from published results of the main trial. Resource use costs were first assessed based on United States Diagnosis-Related Group values for hospitalizations and Current Procedural Terminology codes for outpatient visits and tests. Both were then converted using Canadian local costs. Survival and life expectancy were estimated from Framingham survival data. The incremental cost-effectiveness ratio was expressed as cost per life year gained.


RESULTS
Through 30 days after random assignment, the primary composite end point favoured the enoxaparin group over the unfractionated heparin group (death or recurrent myocardial infarction rate 9.9% versus 12.0%, P<0.001), and was associated with a modest increased cost of $169.50 ($8,757.00 versus $8,587.50, respectively). Life years gained as a result of treatment with enoxaparin was increased by 0.11 years (P<0.05). Enoxaparin was found to be cost-effective, as indicated by an incremental cost-effectiveness ratio of $4,930 with a 99% probability of costing less than $20,000.


CONCLUSIONS
Although associated with modest increased direct medication costs, enoxaparin following fibrinolysis improved the clinical efficacy in STEMI patients and increased the life years gained.
Welsh
Rober C
RC
University of Alberta and Mazankowski Alberta Heart Institute, Edmonton, Canada. rwelsh@cha.ab.ca
Sauriol
Luc
L
Zhang
Zugui
Z
Kolm
Paul
P
Weintraub
Willian S
WS
Theroux
Pierre
P
D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage / Q000191:economics*; D002170:Canada; D003362:Cost-Benefit Analysis; D004311:Double-Blind Method; D017984:Enoxaparin / Q000008:administration & dosage / Q000191:economics*; D005260:Female; D005342:Fibrinolysis; D017048:Health Care Costs / Q000706:statistics & numerical data; D006493:Heparin / Q000008:administration & dosage / Q000191:economics*; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000188:drug therapy / Q000191:economics*; D016896:Treatment Outcome
D000925:Anticoagulants; D017984:Enoxaparin; D006493:Heparin