Background-In the ESSENCE trial, subcutaneous low-molecular-weight heparin (enoxaparin) reduced the 30-day incidence of death, myocardial infarction, and recurrent angina relative to intravenous unfractionated heparin in 3171 patients with acute coronary syndrome (unstable angina or non-Q-wave myocardial infarction).
No increase in major bleeding was seen.
Methods and Results-Of the 936 ESSENCE patients randomized in the United States, 655 had hospital biling data collected.
For the remainder, hospital costs were imputed with a multivariable linear regression model (R2=86).
Physician fees were estimated from the Medicine Fee Schedule.
During the initial hospitalization, major resource use was reduced for enoxaparin patients, with the largest effect seen with coronaryh angioplasty (15% versus 20% for heparin, P=04).
At 30 days, these effects persisted, with the largest reductions seen in diagnostic catheterization (57% versus 63% for heparin, P=04) and coronary angioplasty (18% versus 22%, P.=08).
All resource use trends seen in the US cohort were also evident in the overall ESSENCE study population.
In the United States, the mean cost of a course of enoxaparin therapy was $155, whereas that for heparin was $80.
The total medical costs (hospital, physician, drug) for the initial hospitalization were $11 857 for enoxaparin and $12 620 for heparin, a cost advantage for the enoxaparin arm of $763 (P=18). (...)
Mots-clés Pascal : Angor instable, Infarctus, Myocarde, Enoxaparine sodique, Héparine bas poids moléculaire, Analyse coût efficacité, Economie santé, Chimiothérapie, Traitement, Efficacité traitement, Homme, Anticoagulant, Appareil circulatoire pathologie, Cardiopathie coronaire, Myocarde pathologie
Mots-clés Pascal anglais : Variant angina, Infarct, Myocardium, Enoxaparin sodium, Low molecular weight heparin, Cost efficiency analysis, Health economy, Chemotherapy, Treatment, Treatment efficiency, Human, Anticoagulant, Cardiovascular disease, Coronary heart disease, Myocardial disease
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 98-0260750
Code Inist : 002B02G. Création : 11/09/1998.