title: Cost-Effectiveness Analysis of Fondaparinux vs Enoxaparin in Non-ST Elevation Acute Coronary Syndrome in Thailand.
abstract: BACKGROUND
  Non-ST elevation acute coronary syndrome (NSTE-ACS) imposes a significant health and economic burden on a society. Anticoagulants are recommended as standard therapy by various clinical practice guidelines. Fondaparinux was introduced and evaluated in a number of large randomised, controlled trials. This study therefore aimed to determine the cost-effectiveness of fondaparinux versus enoxaparin in the treatment of NSTE-ACS in Thailand.
  
  
  METHODS
  A two-part construct model comprising a one-year decision tree and a Markov model was developed to capture short and long-term costs and outcomes from the perspective of provider and society. Effectiveness data were derived from OASIS-5 trial while bleeding rates were derived from the Thai Acute Coronary Syndrome Registry (TACSR). Costs data were based on a Thai database and presented in the year of 2013. Both costs and outcomes were discounted by 3% annually. A series of sensitivity analyses were performed.
  
  
  RESULTS
  The results showed that compared with enoxaparin, fondaparinux was a cost-saving strategy (lower cost with slightly higher effectiveness). Cost of revascularisation with major bleeding had a greater impact on the amount of cost saved both from societal and provider perspectives. With a threshold of 160,000 THB ((4,857.3 USD) per QALY in Thailand, fondaparinux was about 99% more cost-effective compared with enoxaparin.
  
  
  CONCLUSIONS
  Fondaparinux should be considered as a cost-effective alternative when compared to enoxaparin for NSTE-ACS based on Thailand's context, especially in the era of limited healthcare resources.
authors.affiliation: Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand. Electronic address: unchalee.permsuwan@gmail.com.
authors.forename: Unchalee
authors.initials: U
authors.lastname: Permsuwan
authors.affiliation: School of Pharmacy, Monash University Malaysia, Malaysia; Center of Pharmaceutical Outcomes Research (CPOR), Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand; School of Population Health, University of Queensland, Brisbane, Australia; School of Pharmacy, University of Wisconsin-Madison, Madison, WI, USA.
authors.forename: Nathorn
authors.initials: N
authors.lastname: Chaiyakunapruk
authors.affiliation: Faculty of Pharmacy, Mahidol University, Bangkok, Thailand.
authors.forename: Surakit
authors.initials: S
authors.lastname: Nathisuwan
authors.affiliation: Department of Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
authors.forename: Apichard
authors.initials: A
authors.lastname: Sukonthasarn
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy* / Q000191:economics*; D000368:Aged; D003365:Costs and Cost Analysis; D017984:Enoxaparin / Q000008:administration & dosage / Q000191:economics; D005260:Female; D000077425:Fondaparinux; D006801:Humans; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D011134:Polysaccharides / Q000008:administration & dosage / Q000191:economics; D013785:Thailand
chemical_list: D017984:Enoxaparin; D011134:Polysaccharides; D000077425:Fondaparinux
keywords: Cost-Effectiveness; Enoxaparin; Fondaparinux; NSTE-ACS; Thailand