When innovative therapies make economic sense: economic analysis of enoxaparin versus unfractionated heparin in the ESSENCE trial--an overview. Efficacy and Safety of Subcutaneous in non-Q Wave Coronary Events.

An economic substudy using intention-to-treat analysis was conducted prospectively to compare the costs of enoxaparin and unfractionated heparin (UFH) therapy in 936 patients enrolled in the United States arm of the multicentre, international Efficacy and Safety of Subcutaneous Enoxaparin in Non-Q-Wave Coronary Events (ESSENCE) trial. Hospital billing data were used for 655 of the American patients. Hospital costs for the remainder of the patients were imputed using a multivariate linear regression model (r2 = 0.86). Physician fees were estimated from the Medicare Fee Schedule. Results indicated that, compared with UFH patients, enoxaparin patients made use of fewer resources during initial hospitalization, with the largest difference in resource use seen for coronary angioplasty patients (15% for enoxaparin versus 20% for UFH patients; P = 0.04). This trend persisted at 30 days, with the largest reductions in resource use occurring in diagnostic catheterization (57% versus 63%, respectively; P = 0.04) and coronary angioplasty (18% versus 22%, respectively; P = 0.08). Although the mean cost for a course of enoxaparin was US $155, compared with US $80 for UFH, total medical costs for hospitalization, physician care and drugs during the initial treatment phase were US $11,857 for enoxaparin therapy versus US $12,620 for UFH therapy, producing a cost advantage of US $763 for enoxaparin therapy (P = 0.18). Cumulative cost savings associated with enoxaparin treatment at 30 days were US $1,172 (P = 0.04). Results suggested that enoxaparin therapy compared with standard UFH therapy improves key clinical outcomes and saves money in patients with acute coronary syndrome.

Duke Scholars

Author Daniel Benjamin Mark Medicine, Cardiology