David Green, MD, PhD reviewing Aljabri A et al. Blood 2016 Oct 28.

Compared with argatroban or bivalirudin, fondaparinux is considerably more cost-effective and is associated with a higher probability of averting adverse events.

Patients with suspected heparin-induced thrombocytopenia (HIT) are at high risk for thromboembolic events and require anticoagulant therapy. The anticoagulant agents currently available in the U.S. to treat HIT patients are argatroban, bivalirudin, and fondaparinux. Argatroban and bivalirudin are administered intravenously in doses that are adjusted based on laboratory monitoring; fondaparinux is given by subcutaneous injection and does not require monitoring.

To compare the cost-effectiveness of these anticoagulants for patients with suspected HIT, investigators used published reports to determine the probabilities of averting adverse events (venous thromboembolism or upper gastrointestinal bleeding) with each agent. They then formulated a model to calculate the cost per adverse event averted.

The primary base-case analysis showed that fondaparinux was considerably less expensive than argatroban or bivalirudin ($151 vs. $1250 and $1466, respectively) and was associated with a higher probability of averting adverse events (0.9989 vs. 0.9957 and 0.9947). The advantages of fondaparinux were retained when average wholesale prices were used in the analysis.

CITATION(S):

Aljabri A et al. Cost-effectiveness of anticoagulants for the management of suspected heparin-induced thrombocytopenia in the US. Blood 2016 Oct 28; [e-pub].

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