Randomized controlled trials (RCTs) demonstrate that fondaparinux is effective for initial treatment of acute venous thromboembolism (VTE). Given the economic burden of VTE coupled with the fact that reimbursement for care of VTE is shrinking, clinicians require information regarding how the choice for initial anticoagulation affects economic endpoints.
We retrospectively analyzed discharge records from over 550 US hospitals to identify patients with an acute VTE (deep vein thrombosis, pulmonary embolism, or both). Subjects could either be admitted for a VTE or develop it while hospitalized for another reason. Hospital charges associated with the initial event represented the primary endpoint while anticoagulant charges and charges for readmissions served as secondary endpoints. We compared charges for fondaparinux- vs. enoxaparin-treated patients. To control for potential confounders (eg, age, demographics, type of presenting VTE, co-morbidities as measured by APR DRG score, hospital characteristics), we utilized generalized linear methods (GLM).
The cohort included 15,040 patients (fondaparinux: n = 266; enoxaparin: n = 14,674). Fondaparinux-treated patients were younger (60 vs. 64 years, p < 0.001), but had more severe illness profiles (APR DRG 3.18 vs. 3.07, p = 0.024). Reflecting this, unadjusted hospital charges were higher for fondaparinux ($88,849) vs. enoxaparin ($76,040) (p = 0.013). After adjustment, this difference was no longer significant (difference=$574, p = 0.906). Crude anticoagulant charges were also similar between fondaparinux and enoxaparin ($2,233 vs. $2,497, respectively, p = 0.108). After multivariate adjustment, however, fondaparinux was associated with lower anticoagulant expenses (difference=$409, p = 0.001). Adjusted total hospital charges, including both for initial hospitalization and for 30-day readmissions, were not different between the two cohorts (p = 0.536).
VTE remains associated with substantial costs. Overall fondaparinux and enoxaparin result in similar economic outcomes when applied as treatment for acute VTE.
Physicians should consider the economic implications of their therapeutic decisions. Treatment with fondaparinux results in overall treatment costs comparable to enoxaparin for VTE. Given the efficacy of fondaparinux, fondaparinux represents an alternative when treating acute VTE.
Andrew Shorr, Grant monies (from industry related sources) Astellas, GSK, J and J, Pfizer, Sanofi; Consultant fee, speaker bureau, advisory committee, etc. Astellas, BI, GSK, J and J, Medicines Co. Merck, Pfizer, Sanofi, Theravance; Other This project was supported by GSK; No Product/Research Disclosure Information