Prophylaxis in patients at risk for venous thromboembolism (VTE) is more cost-effective with the low-molecular-weight heparin enoxaparin compared with the Factor Xa inhibitor fondaparinux, investigators reported here Tuesday at the 74th annual international scientific assembly of the American College of Chest Physicians, or CHEST 2008.

"The annual cost of VTE prophylaxis is around 1.5 billion dollars," principal investigator Dr. Geno J. Merli, of Thomas Jefferson University in Philadelphia, told Reuters Health in an interview before he announced his study findings.

Dr. Merli's team retrospectively reviewed more than 364,000 patient discharges from their institution for individuals aged 40 years or older who had been hospitalized between 2002-2006 with an ICD-9 code indicating VTE risk, such as cancer, heart failure, lung disease, orthopedic or abdominal surgery or serious infection.

Patients all received VTE prophylaxis with either enoxaparin (96.8 per cent) or fondaparinux (3.2 per cent). Mean total direct medical costs of the two approaches were compared.

Enoxaparin discharges had a mean total direct medical cost of $9,755 compared with $12,683 for fondaparinux discharges, for a difference of $2,928, Dr. Merli reported.

After adjusting for patient and hospital characteristics, the costs associated with enoxaparin were $6,479 compared with $6,658 with fondaparinux, for a difference of $179.

The cost of anticoagulant therapy was also lower for enoxaparin discharges than fondaparinux discharges, at $130 and $163, respectively.

"The total adjusted medical cost savings per patient was $442 with enoxaparin compared with fondaparinux," Dr. Merli said. "This is a significant savings, considering the number of patients treated each year for VTE prophylaxis."

"Both drugs are efficacious," Dr. Merli pointed out. "Enoxaparin has been on the market a lot longer. It has a better safety profile and a shorter half-life of 4-1/2 to 6-1/2 hours, compared with 17-20 hours with fondaparinux. The longer half-life increases the potential risk of bleeding complications."

Furthermore, "For fondaparinux, there is no reversing agent, if there are complications. With enoxaparin, we have protamine," he pointed out. Fewer, more manageable complications increase the savings with enoxaparin, he noted.

Assistant Surgeon General Dr. James M. Galloway was a featured speaker here on Monday, reiterating Acting Surgeon General Dr. Steven K. Galson's Call to Action on September 15 to reduce the number of cases of deep vein thrombosis and pulmonary embolism in the United States.

Publisher: Paola Accalai

Source: Reuters
Author: Martha Kerr
Date: Wednesday, October 29, 2008