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Fondaparinux cost-effective for heparin-induced thrombocytopenia
Fondaparinux appeared more cost-effective than IV argatroban or bivalirudin for the treatment of heparin-induced thrombocytopenia, according to study results.
Fondaparinux also led to fewer adverse events.
“Fondaparinux has received increased attention as a non-heparin anticoagulant in the treatment of suspected heparin-induced thrombocytopenia. This selective Factor Xa inhibitor is provided as a daily subcutaneous injection and requires only infrequent laboratory monitoring,” Ahmed Aljabri, PharmD, BCPS, clinical assistant II at the Center for Health Outcomes and Pharmacoeconomic Research at University of Arizona, and colleagues wrote. “Considering its potential clinical utility, the relatively low drug cost, and the lack of frequent laboratory monitoring and dose titration, fondaparinux may provide a reduced risk of adverse effects, as well as significant cost savings over FDA–approved agents.”
Aljabri and colleagues used a decision-tree model to compare the cost-effectiveness of bivalirudin, argatroban and fondaparinux.
Researchers tested the model using probabilistic sensitivity analyses in 2,000 simulations, with a mean heparin-induced thrombocytopenia incidence of 3% based on national reported incidence in the United States.
The model included published data on both drug efficacy and probability of heparin-induced thrombocytopenia-related major bleeding and thromboembolism.
In a primary analysis, fondaparinux was the least expensive at $151, followed by argatroban at $1,250 and bivalirudin at $1,466.
Fondaparinux also appeared associated with more adverse events averted (0.9989) than argatroban (0.9957) and bivalirudin (0.9947).
Fondaparinux remained more cost-effective and more for averting adverse events in secondary and additional sensitivity analyses.
“To our knowledge, this is the first cost-effectiveness analysis comparing treatment dose fondaparinux, argatroban and bivalirudin for the management of suspected heparin-induced thrombocytopenia,” they wrote. “Considering the three agents’ efficacy and safety profiles, the cost savings and adverse events averted by a once-daily fondaparinux subcutaneous injection with limited laboratory monitoring is more advantageous than continuous titration of argatroban or bivalirudin infusions. Our data strongly suggest that, for the United States, fondaparinux is a cost-responsible approach to the management of suspected heparin-induced thrombocytopenia.” – by Andy Polhamus
Disclosure: The researchers report no relevant financial disclosures.