Abstract 3858: Cost and Cost-Effectiveness of Intravenous Enoxaparin Versus Unfractionated Heparin in Elective Percutaneous Coronary Intervention: Results From the STEEPLE Trial
Background: In the STEEPLE trial, 3528 elective PCI patients were randomized to enoxaparin (ENOX) 0.5 mg/kg or 0.75 mg/kg IV without coagulation monitoring or an IV bolus of ACT-adjusted unfractionated heparin (UFH). Patients treated with ENOX had a 27.6% reduction in non-coronary artery bypass graft (CABG)-related bleeding at 48 hours compared with UFH (6.3% vs. 8.7%, p = 0.01). This beneficial effect was primarily due to the reduction in non-CABG-related major bleeding (1.2% vs. 2.8%, p = 0.0009). All efficacy endpoints were similar across treatment groups. We evaluated hospital cost and cost-effectiveness of ENOX compared to UFH based on 30-day results of STEEPLE.
Methods: PCI and bleeding costs were estimated using the APOLLO database (Christiana Care Health System). ENOX was priced at $3.66/mg; UFH at $0.012/U. Reduction in bleeding was the main outcome studied as efficacy was similar. Bootstrap analysis was performed to test the robustness of the results.
Results: Average index hospitalization costs were significantly lower for patients on ENOX compared with UFH ($9454 vs $9616). The higher initial drug costs of ENOX were offset by the savings in hospital costs. Total costs remained lower for patients randomized to ENOX vs UFH ($9647 vs $9688). In bootstrap analysis, ENOX was the dominant strategy (better clinical outcomes and cost savings) in 76.3% of scenarios tested, and incremental cost effectiveness ratios remained less than $1,000 per bleeding averted in 82.7% (Figure⇓).
Conclusions: In patients undergoing elective PCI, enoxaparin has similar efficacy as UFH but reduces the occurrence of non-CABG-related bleeding resulting in potential cost savings.