This Article Figures Only Full Text Full Text (PDF) Online Appendix Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Google Scholar Articles by Marcoff, L. Articles by Weintraub, W. S. PubMed Articles by Marcoff, L. Articles by Weintraub, W. S. Related Collections Related Article

QUARTERLY FOCUS ISSUE: PREVENTION/OUTCOMES: COST-EFFECTIVENESS

Cost Effectiveness of Enoxaparin in Acute ST-Segment Elevation Myocardial Infarction

The ExTRACT–TIMI 25 (Enoxaparin and Thrombolysis Reperfusion for Acute Myocardial Infarction Treatment–Thrombolysis In Myocardial Infarction 25) Study

Leo Marcoff, MD^_*, Zugui Zhang, PhD^_*, Wei Zhang, MS^_*, Edward Ewen, MD^_*, Claudine Jurkovitz, MD, MPH^_*, Prisca Leguet, PharmD, Paul Kolm, PhD^_* and William S. Weintraub, MD^_*,_*

^_* Christiana Care Center for Outcomes Research, Christiana Care Health System, Newark, Delaware
Sanofi-Aventis, Paris, France

Manuscript received March 17, 2009; accepted May 13, 2009.

^_* Reprint requests and correspondence: Dr. William S. Weintraub, Christiana Care Center for Outcomes Research, Christiana Care Health System, 4755 Ogletown-Stanton Road, Newark, Delaware 19718 (Email: wweintraub{at}christianacare.org).

Objectives: We used a U.S. model of health care costs to examine the cost effectiveness of enoxaparin compared with unfractionated heparin (UFH) as adjunctive therapy for fibrinolysis in patients with ST-segment elevation myocardial infarction (STEMI).

Background: The ExTRACT–TIMI 25 (Enoxaparin and Thrombolysis Reperfusion for Acute Myocardial Infarction Treatment–Thrombolysis In Myocardial Infarction 25) study, a large, randomized, multinational trial, demonstrated a reduction in death or nonfatal myocardial infarction when enoxaparin was used instead of UFH as adjunctive therapy for fibrinolysis in patients with STEMI.

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.

Key Words: enoxaparin • thrombolysis • STEMI

Abbreviations and Acronyms   CI = confidence interval   DRG = diagnosis-related group   ICC = intracluster correlation coefficient   ICER = incremental cost-effectiveness ratio   IQR = interquartile range   LMWH = low-molecular-weight heparin   LYG = life-years gained   LYL = life-years lost   MI = myocardial infarction   NHB = net health benefit   NMB = net monetary benefit   PCI = percutaneous coronary intervention   QALY = quality-adjusted life-year   STEMI = ST-segment elevation myocardial infarction   UFH = unfractionated heparin

Related Article

Inside This Issue
J. Am. Coll. Cardiol. 2009 54: A26. [Full Text] [PDF]