Abstract | OBJECTIVES: BACKGROUND: 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.
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Authors | Leo Marcoff, Zugui Zhang, Wei Zhang, Edward Ewen, Claudine Jurkovitz, Prisca Leguet, Paul Kolm, William S Weintraub |
Journal | Journal of the American College of Cardiology
(J Am Coll Cardiol)
Vol. 54
Issue 14
Pg. 1271-9
(Sep 29 2009)
ISSN: 1558-3597 [Electronic] United States |
PMID | 19778669
(Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
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Chemical References |
- Enoxaparin
- Fibrinolytic Agents
- Heparin
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Topics |
- Aged
- Aged, 80 and over
- Cost-Benefit Analysis
- Double-Blind Method
- Enoxaparin
(economics, therapeutic use)
- Female
- Fibrinolytic Agents
(economics, therapeutic use)
- Heparin
(economics, therapeutic use)
- Hospitalization
(economics)
- Humans
- Life Expectancy
- Male
- Middle Aged
- Models, Economic
- Myocardial Infarction
(drug therapy, mortality)
- Quality-Adjusted Life Years
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