ECONOMIC-ASSESSMENT OF LOW-MOLECULAR-WEIGHT HEPARIN (ENOXAPARIN) VERSUS UNFRACTIONATED HEPARIN IN ACUTE CORONARY SYNDROME PATIENTS - RESULTS FROM THE ESSENCE RANDOMIZED TRIAL

Background-In the ESSENCE trial, subcutaneous low-molecular-weight hep arin (enoxaparin) reduced the 30-day incidence of death, myocardial in farction, 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 w as seen. Methods and Results-Of the 936 ESSENCE patients randomized in the United States, 655 had hospital billing data collected. For the r emainder, hospital costs were imputed with a multivariable linear regr ession model (R-2=.86). Physician fees were estimated from the Medicar e Fee Schedule. During the initial hospitalization, major resource use was reduced for enoxaparin patients, with the largest effect seen wit h coronary angioplasty (15% versus 20% for heparin, P=.04). At 30 days , these effects persisted, with the largest reductions seen in diagnos tic catheterization (57% versus 63% for heparin, P=.04) and coronary a ngioplasty (18% versus 22%, P=.08). All resource use trends seen in th e 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 85 7 for enoxaparin and $12 620 for heparin, a cost advantage for the eno xaparin arm of $763 (P=.18). At the end of 30 days, the cumulative cos t savings associated with enoxaparin was $1172 (P=.04). In 200 bootstr ap samples of the 30-day data, 93% of the samples showed a cost advant age for enoxaparin. Conclusions-In patients with acute coronary syndro me, low-molecular-weight heparin (enoxaparin) both improves important clinical outcomes and saves money relative to therapy with standard un fractionated heparin.