Abstract 17199: Cost-Effectiveness of Fondaparinux versus Enoxaparin in Non-st-Elevation Acute Coronary Syndrome in Canada. Oasis-5
Purpose: To estimate the lifetime cost-effectiveness of fondaparinux compared to enoxaparin for non-ST-elevation acute coronary syndrome (NSTE-ACS) patients in a Canadian hospital setting.
Methods: An event-based decision analytic model was constructed using clinical and resource use data from OASIS-5, a randomised trial of 20,078 patients from 41 countries. A public payer perspective in the hospital setting was adopted. The probabilities of death, non-fatal myocardial infarction (MI), non-fatal stroke, and major and minor bleeds over a period of 180 days, for both treatment strategies, were estimated using a set of risk equations derived from OASIS-5 data. Resource use data from the trial were valued using Canadian costs. A cost regression model was developed to estimate the mean cost of managing the clinical events over the 180 day period. Annual costs of long-term care for ACS patients were added after 180 days until death. Long-term survival was incorporated using Canadian life tables with further adjustment for additional risks associated with NSTE-ACS. Quality-of-life (utility) decrements from published sources were applied to clinical events. Lifetime costs (2009 CAD$) and quality-adjusted life-years (QALYs), discounted annually at 5%, were estimated for the typical patient in OASIS-5 (i.e., at mean covariate values). Incremental cost-effectiveness ratios (ICERs) were output at 180 days and over the entire lifetime. Probabilistic sensitivity analysis (PSA) was carried out to assess parameter uncertainty.
Results: The trial data showed that fondaparinux is protective against all clinical events observed in the trial. The model showed that: over 180 days, fondaparinux dominates enoxaparin, producing similar estimates of QALYs gained and saving $441; over a patient's lifetime, fondaparinux yields an ICER of $3,869/QALY. Based on PSA, the probabilities that fondaparinux dominates enoxaparin (less costly and more effective) and that is cost-effective at a $50,000 threshold were 41% and 96%, respectively.
Conclusions: In the Canadian hospital setting, fondaparinux is cost-effective when compared to enoxaparin for the treatment of NSTE-ACS. This result holds both in the immediate post-event period and over the lifetimes of patients.
- © 2010 by American Heart Association, Inc.