Cost-Effectiveness Analysis of Fondaparinux vs Enoxaparin in Non-ST Elevation Acute Coronary Syndrome in Thailand

Permsuwan, Unchalee, Chaiyakunapruk, Nathorn, Nathisuwan, Surakit and Sukonthasarn, Apichard (2015) Cost-Effectiveness Analysis of Fondaparinux vs Enoxaparin in Non-ST Elevation Acute Coronary Syndrome in Thailand. Heart Lung and Circulation, 24 9: 860-868. doi:10.1016/j.hlc.2015.02.018


Author Permsuwan, Unchalee
Chaiyakunapruk, Nathorn
Nathisuwan, Surakit
Sukonthasarn, Apichard
Title Cost-Effectiveness Analysis of Fondaparinux vs Enoxaparin in Non-ST Elevation Acute Coronary Syndrome in Thailand
Journal name Heart Lung and Circulation   Check publisher's open access policy
ISSN 1443-9506
1444-2892
Publication date 2015-03-14
Year available 2015
Sub-type Article (original research)
DOI 10.1016/j.hlc.2015.02.018
Volume 24
Issue 9
Start page 860
End page 868
Total pages 9
Place of publication Chatswood, NSW Australia
Publisher Elsevier
Collection year 2016
Language eng
Formatted abstract
Background
Non-ST elevation acute coronary syndrome (NSTE-ACS) imposes a significant health and economic burden on a society. Anticoagulants are recommended as standard therapy by various clinical practice guidelines. Fondaparinux was introduced and evaluated in a number of large randomised, controlled trials. This study therefore aimed to determine the cost-effectiveness of fondaparinux versus enoxaparin in the treatment of NSTE-ACS in Thailand.

Methods
A two-part construct model comprising a one-year decision tree and a Markov model was developed to capture short and long-term costs and outcomes from the perspective of provider and society. Effectiveness data were derived from OASIS-5 trial while bleeding rates were derived from the Thai Acute Coronary Syndrome Registry (TACSR). Costs data were based on a Thai database and presented in the year of 2013. Both costs and outcomes were discounted by 3% annually. A series of sensitivity analyses were performed.

Results
The results showed that compared with enoxaparin, fondaparinux was a cost-saving strategy (lower cost with slightly higher effectiveness). Cost of revascularisation with major bleeding had a greater impact on the amount of cost saved both from societal and provider perspectives. With a threshold of 160,000 THB ((4,857.3 USD) per QALY in Thailand, fondaparinux was about 99% more cost-effective compared with enoxaparin.

Conclusion
Fondaparinux should be considered as a cost-effective alternative when compared to enoxaparin for NSTE-ACS based on Thailand's context, especially in the era of limited healthcare resources.
Keyword Cost Effectiveness
Enoxaparin
Fondaparinux
NSTE ACS
Thailand
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2016 Collection
School of Public Health Publications
 
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