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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 and Brian Erstad

Article Figures & Data

Figures

  • Figure 1.

    Decision-analysis tree. The decision-analysis tree model starts when HIT is suspected and all forms of heparin are discontinued. Hypothetical patients are initiated on argatroban, bivalirudin or fondaparinux. The model assumes laboratory tests would be readily available after 2 days to confirm HIT diagnosis and continue treating patients with nonheparin anticoagulants for a total of 6 days or exclude the diagnosis of HIT and stop nonheparin anticoagulant after 2 days. The model assumed 3 expected outcomes while on nonheparin anticoagulant: HIT-related VTE, major bleeding, or no complication. The baseline rates of outcomes reported in studies and the calculated probabilities of these outcomes can be seen in this figure. BR, baseline rate; P, probability; Ref, reference.

  • Figure 2.

    Probabilistic sensitivity analysis using institutional drug costs. Two thousand simulation samples were used to confirm analysis using institutional costs. y-axis represents the incremental cost and x-axis represents incremental adverse event averted. Samples in north quadrants indicate more expensive drug, while samples in south quadrants indicate more cost savings. East quadrants represent a higher rate of adverse events averted, and samples in west quadrants mean a lower rate of adverse events averted. (A) Argatroban compared with fondaparinux. (B) Argatroban compared with bivalirudin. (C) Bivalirudin compared with fondaparinux.

  • Figure 3.

    Probabilistic sensitivity analysis using average wholesale prices. Two thousand simulation samples were used to confirm analysis using average wholesale prices. y-axis represents the incremental cost, and x-axis represents incremental adverse event averted. Samples in north quadrants indicate more expensive drug, while samples in south quadrants indicate more cost savings. East quadrants represent a higher rate of adverse events averted, and samples in west quadrants mean a lower rate of adverse events averted. (A) Argatroban compared with fondaparinux. (B) Argatroban compared with bivalirudin. (C) Bivalirudin compared with fondaparinux.

Tables

  • Table 1.

    Cost of adverse events, laboratory tests, administration time, and drug per patient

    ItemCost, $Reference
    Cost of VTE management per patient31 878.1843
    Cost of major bleeding (GI) management per patient14 183.3344
    Argatroban 2-d cost of administration411.4346
    Argatroban 6-d cost of administration2 178.9846
    Bivalirudin 2-d cost of administration411.4346
    Bivalirudin 6-d cost of administration2 178.9846
    Fondaparinux cost of administration25.4046
    aPTT test12.7345
    Argatroban (1 vial of 250 mg/2.5 mL)
     Institutional cost331.00BUMC
     AWP1 194.6542
    Bivalirudin (1 vial of 250 mg/5 mL)
     Institutional cost418.00BUMC
     AWP753.0742
    Fondaparinux (1 prefilled syringe of 7.5 mg)
     Institutional cost32.72BUMC
     AWP220.3442
    • BUMC, Banner University Medical Center.

  • Table 2.

    Cost-effectiveness analysis results using institutional costs and AWP

    Institutional costAWP
    Primary base-case analysisPSASecondary base-case analysisPSA
    DrugCost, $AEACost, $AEACost, $AEACost, $AEA
    Argatroban12500.995711860.995730810.995730170.9958
    Bivalirudin14660.994714000.994721870.994721210.9948
    Fondaparinux1510.99891510.99895550.99895550.9989
    • AEA, adverse event averted.