Cost-effectiveness of anticoagulants for suspected heparin-induced thrombocytopenia in the United States

Ahmed Aljabri, Yvonne Huckleberry, Jason H. Karnes, Mahdi Gharaibeh, Hussam I. Kutbi, Yuval Raz, Seongseok Yun, Ivo Abraham, Brian Erstad

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Despite the availability of multiple nonheparin anticoagulants for the treatment of heparin-induced thrombocytopenia (HIT), few data are available comparing the cost-effectiveness of these agents. This analysis is particularly important when considering differences in the risk 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 from the institutional perspective. A 3-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 analyses (PSA) to address any uncertainty in model parameters. Using institutional costs, fondaparinux prevailed over both argatroban and bivalirudin in terms of cost ($151 vs $1250 and $1466, 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 $3081 and $2187, 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. In conclusion, fondaparinux subcutaneous injection afforded significant advantages in terms of cost savings and adverse events averted compared with IV 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.

Original languageEnglish (US)
Pages (from-to)3043-3051
Number of pages9
JournalBlood
Volume128
Issue number26
DOIs
StatePublished - Dec 29 2016

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Cost effectiveness
Thrombocytopenia
Anticoagulants
Cost-Benefit Analysis
Heparin
Costs
Costs and Cost Analysis
Cost Savings
Decision Trees
Drug Costs
Phlebotomy
Thromboembolism
Subcutaneous Injections
Monitoring
Uncertainty
Decision trees
fondaparinux
Pharmaceutical Preparations
Therapeutics
Hemorrhage

ASJC Scopus subject areas

  • Immunology
  • Biochemistry
  • Hematology
  • Cell Biology

Cite this

Cost-effectiveness of anticoagulants for suspected heparin-induced thrombocytopenia in the United States. / Aljabri, Ahmed; Huckleberry, Yvonne; Karnes, Jason H.; Gharaibeh, Mahdi; Kutbi, Hussam I.; Raz, Yuval; Yun, Seongseok; Abraham, Ivo; Erstad, Brian.

In: Blood, Vol. 128, No. 26, 29.12.2016, p. 3043-3051.

Research output: Contribution to journalArticle

Aljabri, Ahmed ; Huckleberry, Yvonne ; Karnes, Jason H. ; Gharaibeh, Mahdi ; Kutbi, Hussam I. ; Raz, Yuval ; Yun, Seongseok ; Abraham, Ivo ; Erstad, Brian. / Cost-effectiveness of anticoagulants for suspected heparin-induced thrombocytopenia in the United States. In: Blood. 2016 ; Vol. 128, No. 26. pp. 3043-3051.
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AU - Kutbi, Hussam I.

AU - Raz, Yuval

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AB - Despite the availability of multiple nonheparin anticoagulants for the treatment of heparin-induced thrombocytopenia (HIT), few data are available comparing the cost-effectiveness of these agents. This analysis is particularly important when considering differences in the risk 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 from the institutional perspective. A 3-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 analyses (PSA) to address any uncertainty in model parameters. Using institutional costs, fondaparinux prevailed over both argatroban and bivalirudin in terms of cost ($151 vs $1250 and $1466, 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 $3081 and $2187, 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. In conclusion, fondaparinux subcutaneous injection afforded significant advantages in terms of cost savings and adverse events averted compared with IV 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.

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