DeMaria, J

Valgimigli, M

Wong, B

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PCV115 TIROFIBAN IS MORE COST-EFFICIENT THAN ABCIXIMAB IN ACHIEVING ST-SEGMENT RESOLUTION FOLLOWING ACUTE MYOCARDIAL INFARCTION 

A334 Paris Abstracts
therapy for primary CVD prevention saves patients money and increases QALYs, but 
at the expense of lost life years.
PCV112
COST EFFECTIVENESS OF RIVAROXABAN AND DABIGATRAN 
ETEXILATE FOR THE PROPHYLAXIS OF VENOUS THROMBOEMBOLISM 
AND ASSOCIATED LONG TERM COMPLICATIONS POST TOTAL HIP 
REPLACEMENT IN IRELAND
McCullagh L1, Tilson L1, Walsh C2, Barry M1
1National Centre for Pharmacoeconomics, Dublin, Ireland, 2Trinity College Dublin, Dublin, 
Ireland
OBJECTIVES: To evaluate the cost-effectiveness of rivaroxaban and dabigatran com-
pared to enoxaparin as venous-thromboembolism prophylaxis post total hip replace-
ment (THR), from the Irish health payer perspective. METHODS: A hybrid model 
combing an acute phase decision tree (180 days post-surgery) and a chronic phase 
Markov model (patient lifetime) was developed using TreeAge Pro 2008®. Outcome 
measures were QALYs and LYGs. Future costs and outcomes were discounted at 4%. 
Treatment efﬁcacy and major bleeding probabilities were derived from pivotal clinical 
trials. Thromboprophylaxis independent probabilities were identiﬁed via a literature 
search. A one-way sensitivity analysis of all probabilities was completed using the 
upper/lower bounds of the 95% conﬁdence interval where available; otherwise point 
estimates were varied o 50%. A probabilistic sensitivity analysis (PSA) using second 
order Monte Carlo simulation was performed. Probabilities were assigned beta distri-
butions. Dirichlet distributions were adopted for multibranch nodes. Utilities and 
direct costs were given beta and lognormal distributions respectively. RESULTS: 
Basecase Analyses: Rivaroxaban dominated both dabigatran and enoxaparin. The 
incremental cost-effectiveness ratios for dabigatran relative to enoxaparin were a1885 
per LYG and a1811 per QALY. One-Way Sensitivity Analysis: The model was robust 
to all but three probability variations; the probabilities that a proximal deep vein 
thrombosis (DVT) will occur on dabigatran, a pulmonary embolism or proximal DVT 
will occur on enoxaparin. PSA: At a a45,000/QALY threshold, the probability that 
rivaroxaban was the most cost-effective strategy was 67%, followed by dabigatran 
(19%) and enoxaparin (14%). A cost-effectiveness plane illustrating scatterplots for 
rivaroxaban versus enoxaparin and dabigatran versus enoxaparin was produced. 
Overlap indicates uncertainty that rivaroxaban is more cost-effective than dabigatran. 
CONCLUSIONS: Basecase analyses indicate that rivaroxaban is more cost-effective 
than enoxaparin or dabigatran. PSA indicates that rivaroxaban is the most cost-
 effective strategy at a a45,000/QALY threshold; however there is uncertainty regard-
ing this strategy being more cost-effective than dabigatran.
PCV113
COST-EFFECTIVENESS OF FONDAPARINUX VS ENOXAPARIN IN 
EXTENDED PROPHYLAXIS OF VENOUS THROMBOEMBOLISM IN 
MAJOR ORTHOPEDIC SURGERY IN POLAND
Kawalec P1, Kuzma J1, Glogowski C2, Krzyzanowska A3
1Centrum HTA, Krakow, Poland, 2GSK Commercial Sp. z o.o, Warsaw, Poland, 
3GlaxoSmithKline Poland, Warsaw, Poland
OBJECTIVES: To assess clinical effectiveness and cost–effectiveness of fondaparinux 
vs enoxaparin (40 mg or 30 mg twice a day) in extended prophylaxis (administration 
for 30 days) of venous thromboembolism in patients after major orthopedic surgery 
(knee arthroplasty, hip arthroplasty, hip fracture) in Poland. METHODS: Systematic 
review and clinical effectiveness analysis according to Polish HTA Guidelines were 
performed. Only RCTs with high credibility assessment were included in the systematic 
review (according to EBM). Costs valid from public payer’s perspective (National 
Health Fund) were taken into account and were based on data from 2007. Costs of 
pharmacotherapy were estimated with 100% reimbursement (lump sum patient 
payment 3.2 PLN). Both health effects and costs were discounted with ﬁve percent rate 
applied. Analysis was performed within ﬁve percent year time horizon. Sensitivity 
analysis was performed. RESULTS: The analysis showed that prophylaxis with 
fondaparinux was more expensive than treatment of enoxaparin in greater (40 mg) and 
in smaller (30 mg) doses by 211 PLN or 98 PLN respectively; however brought better 
health outcomes by 0.01 LYGs and 0.003 LYGs per patient. ICERs were estimated at 
21,603 PLN and 29,950 PLN, respectively, both below cost-effectiveness threshold in 
Poland (91,000 PLN  3 times GDP per capita). The sensitivity analysis proved that 
costs of pharmacotherapy with fondaparinux and enoxaparin had the biggest impact 
on results. CONCLUSIONS: Extendeding prophylaxis of venous thromboembolism 
with fondaparinux compared with enoxaparin in patients undergoing major orthope-
dic surgery is cost-effective option from public payer’s perspective in Poland.
PCV114
DABIGATRAN ETEXILATE IS COST-SAVING FOR THE PRIMARY 
PREVENTION OF VENOUS THROMBOEMBOLIC EVENTS FOLLOWING 
MAJOR ORTHOPAEDIC SURGERY IN THE NETHERLANDS
Boersma C1, Kappelhoff BS2, Postma MJ1
1University of Groningen, Groningen, The Netherlands, 2Boehringer Ingelheim bv, Alkmaar, 
The Netherlands
OBJECTIVES: Dabigatran etexilate (DBG) is a new oral direct thrombin inhibitor for 
prophylaxis of venous thromboembolism (VTE) in patients who have undergone total 
hip replacement (THR) or total knee replacement (TKR) surgery. Advantages of DBG 
over parenteral prophylaxis might include but are not limited to reduced resource use 
for 1) teaching patients to self-inject; 2) home-care visits for parenteral administration; 
and 3) absence of Heparin Induced Thrombocytopenia (HIT). Based on proven non-
inferiority, the aim of this study was to conduct a cost-minimization analysis of oral 
DBG versus parenteral low-molecular weight heparin (LMWH) and Fondaparinux 
formulations from the perspective of the Dutch National Health Service. METHODS: 
A retrospective cohort study was conducted to measure resource use associated with 
parenteral prophylaxis. Drug-utilization data were combined with local unit costs. 
Probabilistic sensitivity analysis was performed to account for uncertainty around 
relevant parameters included. RESULTS: Home-care visits for parenteral administra-
tion problems were required by 9.9% (95%CI: 6.4–13.4) and 9.6% (95%CI: 5.8–
13.4) of THR and TKR patients, respectively. Based on costs for 1000 patients treated 
with DBG versus LMWHs, per patient cost-savings with DBG were estimated at 
a24.63 (95%CI: 0.56–54.19) and a18.39 (95%CI: 2.54–41.52) for THR and TKR, 
respectively. The probability that DBG would be cost-saving is 97.1% and 95.6% for 
THR and TKR, respectively. These cost-savings were even higher when including 
Fondaparinux with per patient cost-savings of a84.87 (95%CI: 58.04–117.64) and 
a33.41 (95%CI: 12.27–57.36) for THR and TKR, respectively. Separate calculations 
for DBG versus Nadroparin and Dalteparin in THR resulted in a probability of achieving 
cost-savings with DBG of 19.0% and 100%, respectively. For TKR these probabilities 
for DBG versus Nadroparin and Dalteparin were estimated at 37.0% and 100%. 
CONCLUSIONS: Thromboprophylaxis with DBG is cost-saving in patients undergo-
ing THR/TKR for the perspective of the Dutch National Health Service.
PCV115
TIROFIBAN IS MORE COST-EFFICIENT THAN ABCIXIMAB IN 
ACHIEVING ST-SEGMENT RESOLUTION FOLLOWING ACUTE 
MYOCARDIAL INFARCTION
DeMaria J1, Wong B2, Valgimigli M3
1Iroko Pharmaceuticals, Philadelphia, PA, USA, 2Bruce Wong & Associates Inc., Radnor, PA, 
USA, 3Azienda Opedaliera Universitaria di Ferrara, Ferrara, Italy
OBJECTIVES: Glycoprotein IIb/IIIa inhibitors are highly effective inhibitors of platelet 
aggregation. The MultiStrategy trial showed Tiroﬁban or Abciximab were similarly 
efﬁcacious in resolving ST-segment elevation at 90 min post intervention following 
Acute Myocardial Infarction. As combination therapy to inhibit platelet function and 
the coagulation cascade to improve cardiovascular outcome is increasingly common 
in Acute coronary settings, the focus is turning to cost efﬁcient approaches. We 
undertook a pharmaco-economic analysis of the MultiStrategy study to identify the 
most cost-efﬁcient therapy. METHODS: Cost-minimization analysis of a randomized 
controlled trial, where costs are calculated only when between group statistical differ-
ences are identiﬁed. Direct medical resources (drugs, procedures, investigations, 
adverse effects and duration of stay) were prospectively collected within the case report 
form. Drug costs were average wholesale prices obtained from the manufacturer. 
RESULTS: Drug utilization and major procedural resources between groups was 
similar; Clopidogrel (p  0.71), Aspirin (p  0.18), Heparin (p  0.14); PCI; stents 
(p  0.81), guidewires (p  0.45), non serious adverse events (p  0.41), Bleeding 
(p  0.775), # Days in hospital (p  0.95). Duration of Tiroﬁban infusion was longer 
19.97h vs. 11.44h (p  0.000) whereas, amount of Glycoprotein inhibitor and number 
of required vials of drug was higher for Abciximab 23,491Mg v. 14,328Mg (p  0.000) 
and 2.933 v. 1.707 (p  0.000) respectively. The average calculated cost of Abciximab 
was higher than Tirﬁban 876.93 vs. a348.20 (p  0.000) or a196,787 total cost dif-
ference between study arms (n  361 patients per arm). CONCLUSIONS: All resource 
variables were similar between arms except for the randomized medication. No 
resource implications of medication side-effects or treatment duration were seen. 
Tiroﬁban is the more cost-efﬁcient Glycoprotein IIb/IIIa inhibitor in achieving ST-
segment resolution at 90min post intervention.
PCV116
COST-EFFECTIVENESS OF BIVALIRUDIN VERSUS HEPARIN PLUS 
GLYCOPROTEIN IIB/IIIA INHIBITOR IN THE TREATMENT OF ACUTE 
ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION—A HORIZONS 
TRIAL ANALYSIS USING UK VALUATIONS
Schwenkglenks M1, Szucs TD1, Brazier JE2, Blackman DJ3, Cyr P4, Olchanski N4, Stone GW5
1University of Basel, Basel, Switzerland, 2University of Shefﬁeld, Shefﬁeld, UK, 3Leeds General 
Inﬁrmary, Leeds, UK, 4Boston Healthcare Associates, Inc, Boston, MA, USA, 5Columbia 
University Medical Center, New York, NY, USA
OBJECTIVES: Primary percutaneous coronary intervention (PPCI) has become the 
preferred treatment option for acute ST-segment elevation myocardial infarction 
(STEMI). In the HORIZONS randomised controlled trial, anticoagulation with biva-
lirudin versus heparin plus glycoprotein IIb/IIIa inhibitor (GPI) was associated with 
similar ischemic event rates and signiﬁcantly reduced bleeding events. Mortality at 30 
days and 1 year, in this indication. We estimated the incremental cost-effectiveness of 
bivalirudin in the HORIZONS trial. UK National Health Service valuations and per-
spective were applied. METHODS: A decision tree model compared the bivalirudin 
and heparin plus GPI strategies investigated in HORIZONS. It was combined with a 
Markov module to achieve a life-long time horizon. The health economic endpoint was 
cost per quality-adjusted life-year (QALY) gained. One-year clinical event rates and 
medical resource use parameters were derived from the HORIZONS dataset. Remain-
ing life expectancy and long-term cardiovascular treatment costs of ﬁrst-year survivors, 
unit costs, and utilities were drawn from published UK sources. Costs and effects were 
discounted at 3.5%. Extensive sensitivity analyses were performed. RESULTS: In 
the base case analysis, the bivalirudin strategy was dominant with an average saving 
of £450 per patient and an average survival gain of 0.09 QALYs per patient. Cumula-
tive costs in the bivalirudin and heparin plus GPI strategies were £12,318 and £12,769 
per patient, respectively. Patients lived 6.05 and 5.96 QALYs. A dominant or highly 


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PCV115 TIROFIBAN IS MORE COST-EFFICIENT THAN ABCIXIMAB IN ACHIEVING ST-SEGMENT RESOLUTION FOLLOWING ACUTE MYOCARDIAL INFARCTION

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