PharmacoEconomics & Outcomes News 342 - 8 Dec 2001

recurrence was assumed, enoxaparin sodium wasCardiovascular news from the 4thassociated with a cost per VTE event avoided of 2324Annual ISPOR Meeting euros and a cost per life saved of 8285 euros, relative tono prophylaxis, at 1 year. The corresponding values forThe costs and outcomes associated withthe 5-year timeframe were 2277 and 8934 euros,pharmacotherapies used to treat cardiovascularrespectively, and for the 10-year timeframe were 2254disorders were the topic of several presentations at thisand 10 440 euros, respectively. Over a patient’s lifetime,year’s 4th Annual International Society forenoxaparin sodium resulted in a gain in life expectancy,Pharmacoeconomics and Outcomes Research (ISPOR)as well as an increase in treatment costs; thus, the costMeeting, held in Cannes, France, in November. Theper VTE event avoided was 2243 euros and the cost perfollowing is a summary of 5 of these studies.life-year gained (LYG) was 605 euros. However,

Enoxaparin sodium as thromboprophylaxis enoxaparin sodium became the dominant treatmentInvestigators from MEDTAP International and Aventis option, over a lifetime, when it was assumed that the

Pharmaceuticals, US, found that the administration of risk of VTE recurrence with asymptomatic VTE wasenoxaparin sodium for the prevention of venous equal to that for symptomatic VTE. Costs included thosethromboembolism (VTE) in acutely ill patients is related to protocol drugs, other medications,extremely cost effective in a US healthcare setting.1 consultations, diagnostic tests and VTE events.

Using a Monte Carlo simulation and outcomes dataEnoxaparin sodium vs unfractionatedfrom the international MEDENOX* trial, theheparin for DVTinvestigators estimated the cost effectiveness of

In patients who are undergoing total hip replacementprophylaxis with enoxaparin sodium 40 mg/day for 6–14surgery, anticoagulants such as enoxaparin sodium candays, compared with placebo, in hospitalised patientsprevent deep vein thrombosis (DVT), in addition to(mean age 73 years) with a primary diagnosis of acutesaving costs, say researchers from the US and the UK.3,‡respiratory failure, heart failure or infectious disease, at

They constructed a model using data from thehigh risk of developing VTE.** The investigators noteliterature and clinical expert opinion to evaluate thethat, in patients with a hospital length of stay (LOS) of <short- and long-term cost effectiveness of enoxaparin6 days, costs of enoxaparin sodium administration weresodium 40 mg/day compared with unfractionatedcalculated for an outpatient setting – self-administration,heparin 15 000 U/day. Both agents were administeredoutpatient clinic or home healthcare.for 7 days to hypothetical cohorts of 10 000 patients

Future VTE treatment costs offset? (aged 68 years) undergoing total hip replacementAt day 14 of therapy, the rate of VTE was significantly surgery in the UK. Compared with unfractionated

lower in patients who received enoxaparin sodium than heparin, treatment with enoxaparin sodium resulted inin those who received placebo (5.5 vs 14.9%). 237 cases of DVT prevented and a per-patient saving ofDepending on the inpatient hospital pharmacy about £10 within 2 weeks of surgery; 58 cases of post-dispensing fee (range $US0–$US20 per dose), the thrombotic syndrome and 63 of recurrent VTE (2 of theincremental cost per VTE event avoided with enoxaparin most burdensome long-term complications of DVT)sodium therapy ranged from $US1249 to $US2276 in were prevented, and an extra £35 cost saving per patientthe patient self-administration setting, from $US1587 to was achieved, from week 2 post-surgery until death or$US2613 in the outpatient clinic setting, and from age 100. Overall, enoxaparin sodium therapy was$US2062 to $US3088 in the home healthcare setting. credited with a gain of 0.01 quality-adjusted life-yearsCosts associated with this calculation included those for (QALYs), and per-patient savings of approximately £46,drug acquisition, hospitalisation, pharmacy dispensing, compared with unfractionated heparin therapy.home-health nurse and outpatient clinic visits. Only direct costs were calculated and included

Enoxaparin sodium confers a sizeable reduction in the diagnostic tests, hospitalisations, physician/nurse officerisk of developing VTE for only a small increment in visits, medical supplies, medications and surgery.current treatment costs, the investigators conclude. Sensitivity analyses revealed that the results wereMoreover, ‘there is a reasonable likelihood that the cost sensitive to variations in the model’s parameters.of prophylaxis will be offset by avoided future VTE

Amlodipine worth the cost in CAD . . .treatment’, they say.Two pharmacoeconomic analyses conducted by an

An Italian perspective international research team have shown that amlodipineEnoxaparin sodium is also cost effective as is worth it for patients in the UK with coronary artery

thromboprophylaxis from the perspective of the disease (CAD) or who are undergoing percutaneousNational Health Service (NHS) in Italy, providing both transluminal coronary angioplasty (PTCA).4, 5,†† In theshort- and long-term health economic benefits for first study, a Markov model was used to establish thepatients with acute medical illnesses, according to a economic impact of the use of amlodipine on the totalmultinational research team.2† treatment cost associated with CAD over a 3-year

The MEDENOX trial was again the basis for the period, compared with placebo.4 Patient outcomes dataprobability of VTE events (deep vein thrombosis, were obtained retrospectively from the Prospectivepulmonary embolism and post-thrombotic syndrome). Evaluation of the Vascular Effects of ‘Norvasc’ TrialIn addition, data from other literature, national mortality (PREVENT); however, since the rate of proceduresdata and Delphi-panel-derived resource-use data were undertaken in this trial was specific to the US andused in a Markov model to calculate the cost Canada, the data were adjusted to consider the impacteffectiveness of enoxaparin sodium prophylaxis versus of UK practice.no prophylaxis over 4 time horizons – 1 year, 5 years, 10 The rate of hospitalisation for angina pectoris,years and a lifetime. myocardial infarction (MI), congestive heart failure,

In asymptomatic patients, when no higher risk for VTE PTCA or coronary artery bypass graft (CABG) surgery

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PharmacoEconomics & Outcomes News 8 Dec 2001 No. 3421173-5503/10/0342-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved

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was significantly lower in amlodipine, compared withplacebo, recipients (44.3 vs 61.8%). There was also areduced need for invasive surgeries in the amlodipinegroup. Given that the total expected treatment cost over3 years was marginally higher for amlodipine recipients(£1859 vs £1800 per patient), the cost-effectivenessratio for this drug was about £332 per hospitalisationavoided, relative to placebo. Costs were those related toacute inpatient care and outpatient follow-up care(including medications, laboratory tests and physicianservices).

. . . and in PTCA in the UKThe second analysis was also based on retrospectively

collected data, this time from the Coronary AngioplastyAmlodipine Restenosis Study (CAPARES). Taking a UKNHS perspective, the researchers used decision-analysisto model the costs and outcomes associated withamlodipine versus placebo use in patients undergoingPTCA.5 Over a 4-month period, amlodipine treatmentafforded a significant reduction in the compositeendpoint of major adverse clinical events, comprisingCABG, MI, PTCA and death (6.9 vs 16.3%). Notsurprisingly, costly repeat revascularisation procedures,such as CABG and PTCA, were required by fewerpatients who received amlodipine, compared with thosewho received placebo (4.8 vs 12.2%). Per-patient totalhealthcare costs for the same period were lower foramlodipine, compared with placebo, recipients (£3833vs £4035). ‘The NHS should consider thispharmacoeconomic evidence in developing andpromoting cost-effectiveness policies among healthcareproviders of cardiovascular treatment’, the researchersconclude.* Prophylaxis in Medical Patients with Enoxaparin** The study received financial support from Aventis Pharmaceuticals,US.† Two of the researchers were affiliated with MEDTAP International,The Netherlands, and two were affiliated with Aventis Pharma.‡ One of the researchers was affiliated with Aventis Pharmaceuticals,US.†† Some of the researchers were affiliated with Pfizer, which providedgrant support for the studies.

1. de Lissovoy G, et al. Cost-effectiveness of enoxaparin as venousthromboembolism prophylaxis in acutely ill medical patients. Value in Health 4:496-497 (plus poster), Nov-Dec 2001.

2. Nuijten M, et al. Economic evaluation of enoxaparin in patients with acutemedical illness: an Italian economic study from the Medenox Trial. Value inHealth 4: 494-495 (plus poster), Nov-Dec 2001.

3. Botteman M, et al. Cost effectiveness of enoxaparin vs. unfractionated heparinfor the prophylaxis of DVT and subsequent long-term complications in total hipreplacement surgery in the United Kingdom. Value in Health 4: 495 (plusposter), Nov-Dec 2001.

4. Doyle J, et al. Cost-effectiveness of amlodipine treatment in patients withcoronary artery disease in the U.K. Value in Health 4: 494 (plus poster), Nov-Dec 2001.

5. Casciano R, et al. A health-economic analysis of the use of amlodipine inpatients undergoing percutaneous transluminal coronary angioplasty in the U.K.Value in Health 4: 496 (plus poster), Nov-Dec 2001.

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