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

Marcoff, Leo; Zhang, Zugui; Zhang, Wei; Ewen, Edward; Jurkovitz, Claudine; Leguet, P; Kolm, Paul; Weintraub, William S.

doi:10.1016/j.jacc.2009.05.060

Cited by 8 publications

(5 citation statements)

References 31 publications

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“…A third study ignored data from all other countries and used data from only the country of interest [ 25 ]. Empirical Bayesian shrinkage, a method that involves borrowing strength from the overall trial to estimate country-specific cost-effectiveness [ 54 ], was used by only one study; however, the authors did not present the country-specific estimates [ 27 ]. The simplest approach was to state that the perspective of the analysis was related to a particular country and to apply unit costs from that country to the trial-wide data [ 34 , 36 , 37 , 46 , 52 ].…”

Section: Resultsmentioning

confidence: 99%

“…Multilevel modelling was used in three studies to account for the clustered nature of the data [ 27 , 49 , 50 ]. Other regression approaches such as controlling for country when estimating outcomes such as the QALY [ 43 ], adjusting for length of stay and costs within countries [ 51 ] and including interaction terms and country dummy variables [ 34 , 39 , 44 , 52 ] were also used.…”

Section: Resultsmentioning

confidence: 99%

“…It was noted that there are numerous differences between countries but no accepted guidance on how to account for them [ 35 , 46 , 53 ]. These differences include: differences in resource use, prices, health systems and practice patterns [ 27 – 29 , 31 , 39 , 46 , 47 , 52 , 54 , 58 – 60 ]. Estimating country-specific cost-effectiveness was another area in which there is no consensus amongst researchers [ 35 , 46 ].…”

Section: Resultsmentioning

confidence: 99%

“…The most common method of obtaining country-specific estimates was fully pooled one-country costing. Current recommendations by the ISPOR taskforce suggest that the more complex methods such as hierarchical modeling should be used for the analysis of multinational trial data [ 18 ] and a recent study also concluded that Bayesian hierarchical models are the most appropriate for estimating country-specific cost-effectiveness [ 22 ]; however, only one study in this review used this approach [ 27 ], suggesting that researchers are not adhering to existing guidelines, possibly because of the complexity associated with implementing this approach. Bayesian hierarchical models have been challenged because it assumes that differences between countries are random, whereas in reality, these differences are systematic [ 72 ].…”

Section: Discussionmentioning

confidence: 99%

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Economic Evaluation alongside Multinational Studies: A Systematic Review of Empirical Studies

2015

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Purpose of the studyThis study seeks to explore methods for conducting economic evaluations alongside multinational trials by conducting a systematic review of the methods used in practice and the challenges that are typically faced by the researchers who conducted the economic evaluations.MethodsA review was conducted for the period 2002 to 2012, with potentially relevant articles identified by searching the Medline, Embase and NHS EED databases. Studies were included if they were full economic evaluations conducted alongside a multinational trial.ResultsA total of 44 studies out of a possible 2667 met the inclusion criteria. Methods used for the analyses varied between studies, indicating a lack of consensus on how economic evaluation alongside multinational studies should be carried out. The most common challenge appeared to be related to addressing differences between countries, which potentially hinders the generalisability and transferability of results. Other challenges reported included inadequate sample sizes and choosing cost-effectiveness thresholds.ConclusionsIt is recommended that additional guidelines be developed to aid researchers in this area and that these be based on an understanding of the challenges associated with multinational trials and the strengths and limitations of alternative approaches. Guidelines should focus on ensuring that results will aid decision makers in their individual countries.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Economic Evaluation alongside Multinational Studies: A Systematic Review of Empirical Studies

2015

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“…Enoxaparin was shown to be an economically attractive option with an ICER of $5,700 per LY gained. (37) However, these data may not represent the contemporary practice where patients are managed primarily with primary PCI instead of fibrinolytic therapy.…”

Section: Cost Effectiveness Of Antithrombotic Use In Acute Coronarmentioning

confidence: 99%

Cost Effectiveness of Antiplatelet and Antithrombotic Therapy in the Setting of Acute Coronary Syndrome: Current Perspective and Literature Review

Fanari

Weiss

Weintraub

2015

Am J Cardiovasc Drugs

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Acute Coronary Syndromes are associated with high rates of morbidity and mortality. The advances of antiplatelet and anticoagulation therapy over several years time have result in in improved in cardiac outcomes, but with increased health care costs. Multiple cost effectiveness studies have been performed to evaluate the use of available antiplatelet agents and anticoagulation in the setting of both ST Elevation myocardial infarction (STEMI) and Non–ST Elevation Acute Coronary Syndrome (NSTE-ACS). Early on the use of GPI prove to be economically attractive in the management of ACS, however the introduction of P2Y12 receptor antagonist limited their use to a bail out agents in complex interventions. Generic clopidogrel is probably still an economically attractive P2Y12 receptor antagonist choice especially in low risk ACS, while both ticagrelor and prasugrel present an economically attractive alternative option especially in high risk ACS and patients at risk for stent thrombosis. While enoxaparin presents an economically dominant alternative to heparin in NSTE-ACS, its role in STEMI in the contemporary era is unclear. During PCI, bivalirudin monotherapy was shown to be an economically dominant alternative to the combination of heparin and GPI in ACS. However, new studies may suggest that using heparin monotherapy may offer an attractive alternative. The comparative and cost effectiveness of different combinations of antiplatelet and antithrombotic therapy will be the focus of future expected clinical and economic assessments.

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Economic Considerations for Complex Mixture Drugs

Lin¹

2019

The Science and Regulations of Naturally Derived Complex Drugs

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

Abstract: 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.

Cited by 8 publications

References 31 publications

Economic Evaluation alongside Multinational Studies: A Systematic Review of Empirical Studies

Economic Evaluation alongside Multinational Studies: A Systematic Review of Empirical Studies

Cost Effectiveness of Antiplatelet and Antithrombotic Therapy in the Setting of Acute Coronary Syndrome: Current Perspective and Literature Review

Economic Considerations for Complex Mixture Drugs

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