[Economic consequences of biological monitoring and medical complications of injectable anticoagulants in France].
OBJECTIVE
To assess the frequency of platelet monitoring and bleeding risks associated with the use of injectable anticoagulants in a real life setting and to estimate the associated costs.


METHODS
An analysis of the 2013 data from a random sample of ≈600,000 patients registered in the French National Health Insurances reimbursement database was conducted to identify platelet counts performed during injectable anticoagulants exposure period and treatment interruptions due to heparin-induced thrombocytopenia or transfusion. Events were then valued to establish associated costs.


RESULTS
Overall 15,985 adult patients representing a cumulated injectable anticoagulants exposure time of 12,264 months were selected. Treatment sequences involved unfractionated heparin (2.8%), low molecular weight heparin (86.9%), and fondaparinux (13.1%). Patients treated with unfractionated heparin were older (77 vs. 57 and 59 years) with longer treatment duration (32.6 vs. 25.1 and 21 days). After statistical adjustment, the average monthly number of platelet counts was 1.36-fold lower in patients treated with fondaparinux compared to low molecular weight heparin (P<0.0001). No difference was found between low molecular weight heparin and fondaparinux regarding the incidence of bleeding with transfusion (P=0.76) or hospitalized thrombocytopenia (P=0.82). Extrapolated for the whole country, the estimated costs for biological monitoring were € 21.6 million for low molecular weight heparin and € 0.9 million for fondaparinux.


CONCLUSIONS
Significantly fewer platelet counts were performed among patients treated with fondaparinux than among patients receiving low molecular weight heparin without additional bleeding risk. This finding should be taken into account when assessing the costs of such treatments.
Faculté des sciences pharmaceutiques et biologiques, université Paris Descartes, 12, rue de l'École-de-Médecine, 75270 Paris, France.
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Paubel
Cemka-Eval, 43, boulevard du Maréchal-Joffre, 92340 Bourg-la-Reine, France.
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Cousin
Aspen, 100, route de Versailles, 78160 Marly-le-Roi, France.
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Amar
Inserm U1018, 16, avenue P.V.-Couturier, 94807 Villejuif, France.
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Gourmelen
Cemka-Eval, 43, boulevard du Maréchal-Joffre, 92340 Bourg-la-Reine, France.
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Fabron
Cemka-Eval, 43, boulevard du Maréchal-Joffre, 92340 Bourg-la-Reine, France. Electronic address: bruno.detournay@cemka.fr.
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Detournay
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects* / Q000191:economics; D003365:Costs and Cost Analysis; D004784:Environmental Monitoring / Q000191:economics*; D005260:Female; D000077425:Fondaparinux; D005602:France; D006470:Hemorrhage; D006493:Heparin / Q000008:administration & dosage / Q000009:adverse effects; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D011134:Polysaccharides / Q000008:administration & dosage / Q000009:adverse effects; D012307:Risk Factors; D013921:Thrombocytopenia / Q000139:chemically induced / Q000453:epidemiology
D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D011134:Polysaccharides; D006493:Heparin; D000077425:Fondaparinux
Blood cell count; Coûts des soins de santé; Drug therapy; Fondaparinux; Health care costs; Heparin; Héparine de bas poids moléculaire; Low molecular weight; Numération formule sanguine; Traitement médicamenteux