PURPOSE: Fondaparinux (F) represents a new option for deep vein thrombosis (DVT) therapy and is as equally as effective as low-molecular weight heparin (LMWH)for acute anticoagulation in this disease. F, though, may offer financial advantages since it is given as a fixed dose over a range of patient weights and because it is not associated with heparin-induced thrombocytopenia (HIT). We hypothesized that because of this, F would prove cost-effective for DVT treatment.
METHODS: We conducted a cost-minimization analysis comparing F to enoxaparin (E) for acute anticoagulation in DVT. We modeled a cohort of 1,000 hypothetical subjects and drew estimates for model inputs from the literature and from meta-analyses regarding the incidence of bleeding and HIT with LMWH. Costs of clinical events were taken from reports measuring the economic consequences of these outcomes. We biased the model against F and did not include fixed costs. We completed multiple sensitivity analyses and used Monte Carlo simulation to estimate the 95% confidence intervals (CIs) around the per patient cost differential for the two agents.
RESULTS: In the base case, total disease management costs per patient with fondaparinux are $474 vs. $802 with E. The 95% CI around this difference ranges from $52 to $428, and in 99.3% of simulations there are savings with F. The model was mildly sensitive to the acquisition costs of F and E. Neither the rates of nor costs associated with DVT recurrence, major bleeding, nor HIT substantially affected our observations. In our worst-case scenario (all variables simultaneously skewed to their farthest extreme against F), one generates savings with E ($18/patient). Breakeven analysis indicated our findings to be robust over a wide range of likely clinical scenarios.
CONCLUSION: From the perspective of a healthcare system, F use offers an attractive economic alternative to LMWH for initial DVT therapy.
CLINICAL IMPLICATIONS: Expanded reliance on F could potentially results in savings.
DISCLOSURE: Andrew Shorr, Grant monies (from industry related sources) GSK, Sanofi Aventis; Consultant fee, speaker bureau, advisory committee, etc. GSK, Sanofi Aventis.