title: Cost-effectiveness of anticoagulants for suspected heparin-induced thrombocytopenia in the United States.
abstract: Despite the availability of multiple nonheparin anticoagulants for the treatment of heparin-induced thrombocytopenia (HIT), few data are available comparing the cost-effectiveness of these agents. This analysis is particularly important when considering differences in the risk of adverse effects, routes of administration, requirements for phlebotomy and laboratory monitoring, and overall drug costs. We conducted a cost-effectiveness analysis of argatroban, bivalirudin, and fondaparinux for the treatment of suspected HIT from the institutional perspective. A 3-arm decision-tree model was developed that employs standard practices for anticoagulation monitoring. We incorporated published data on drug efficacy and probability of HIT-related thromboembolism and major bleeding. We considered both institutional costs and average wholesale price (AWP) and performed probabilistic sensitivity analyses (PSA) to address any uncertainty in model parameters. Using institutional costs, fondaparinux prevailed over both argatroban and bivalirudin in terms of cost ($151 vs $1250 and $1466, respectively) and adverse events averted (0.9989 vs 0.9957 and 0.9947, respectively). Results were consistent when AWP was used, with fondaparinux being less expensive ($555 vs $3081 and $2187, respectively) and more effective in terms of adverse events averted (0.9989 vs 0.9957 and 0.9947, respectively). The PSA confirmed our findings using both institutional costs and AWP. In conclusion, fondaparinux subcutaneous injection afforded significant advantages in terms of cost savings and adverse events averted compared with IV argatroban or bivalirudin infusions. Our data strongly suggest potential cost savings with fondaparinux and underscore the critical need for larger clinical studies of fondaparinux in the treatment of suspected HIT.
authors: Center for Health Outcomes and PharmacoEconomic Research, University of Arizona, Tucson, AZ.|College of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia.
authors: Ahmed
authors: A
authors: Aljabri
authors: Banner University Medical Center, Tucson, AZ.
authors: Yvonne
authors: Y
authors: Huckleberry
authors: Department of Pharmacy Practice and Science, College of Pharmacy, and.|Sarver Heart Center, University of Arizona, Tucson, AZ.
authors: Jason H
authors: JH
authors: Karnes
authors: Center for Health Outcomes and PharmacoEconomic Research, University of Arizona, Tucson, AZ.
authors: Mahdi
authors: M
authors: Gharaibeh
authors: Center for Health Outcomes and PharmacoEconomic Research, University of Arizona, Tucson, AZ.|College of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia.
authors: Hussam I
authors: HI
authors: Kutbi
authors: Division of Pulmonary and Critical Care, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA; and.
authors: Yuval
authors: Y
authors: Raz
authors: H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL.
authors: Seongseok
authors: S
authors: Yun
authors: Center for Health Outcomes and PharmacoEconomic Research, University of Arizona, Tucson, AZ.|Department of Pharmacy Practice and Science, College of Pharmacy, and.
authors: Ivo
authors: I
authors: Abraham
authors: Center for Health Outcomes and PharmacoEconomic Research, University of Arizona, Tucson, AZ.|Department of Pharmacy Practice and Science, College of Pharmacy, and.
authors: Brian
authors: B
authors: Erstad
mesh_terms: D000925:Anticoagulants / Q000191:economics* / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D006493:Heparin / Q000009:adverse effects*; D006801:Humans; D011336:Probability; D013921:Thrombocytopenia / Q000139:chemically induced* / Q000188:drug therapy*; D014481:United States
chemical_list: D000925:Anticoagulants; D006493:Heparin