Abstract 15582: Cost-effectiveness of Anticoagulants for the Management of Suspected Heparin-induced Thrombocytopenia in the US
Introduction: Despite the availability of multiple non-heparin anticoagulants for the treatment of heparin-induced thrombocytopenia (HIT), little data are available comparing the cost effectiveness of these agents. This analysis is particularly important considering differences in risks of adverse effects, routes of administration, requirements for phlebotomy and laboratory monitoring, and overall drug costs. We conducted a cost-effectiveness analysis of argatroban, bivalirudin, and fondaparinux for the treatment of suspected HIT.
Methods: A three-arm decision-tree model was developed that employs standard practices for anticoagulation monitoring. We incorporated published data on drug efficacy and probability of HIT-related thromboembolism and major bleeding. We considered both institutional costs and Average Wholesale Price (AWP) and performed probabilistic sensitivity analysis (PSA) to address any uncertainty in model parameters.
Results: Using institutional costs, fondaparinux outperformed both argatroban and bivalirudin in terms of cost ($151 vs. $1,250 and $1,466, respectively) and adverse events averted (0.9989 vs. 0.9957 and 0.9947, respectively). Results were consistent when AWP was used, with fondaparinux being less expensive ($555 vs. $3,081 and $2,187, respectively) and more effective in terms of adverse events averted (0.9989 vs. 0.9957 and 0.9947, respectively). The PSA confirmed our findings using both institutional costs and AWP.
Conclusions: Fondaparinux subcutaneous injection afforded significant advantages in terms of cost savings and adverse events averted compared to intravenous argatroban or bivalirudin infusions. Our data strongly suggest potential cost savings with fondaparinux and underscore the critical need for larger clinical studies of fondaparinux in the treatment of suspected HIT.
Author Disclosures: A. Aljabri: None. Y.H. Huckleberry: None. J.H. Karnes: None. M. Gharaibeh: None. H. Kutbi: None. Y. Raz: None. S. Yun: None. I. Abraham: None. B. Erstad: None.
- © 2016 by American Heart Association, Inc.