Related Experiment Video
Updated: May 21, 2026
The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
Cost-effectiveness of fondaparinux in patients with acute coronary syndrome without ST-segment elevation
Camila Pepe1, Márcio Machado, Alexandre Olimpio
1MedInsight Evidências, São Paulo, SP.
Insights
Fondaparinux is more effective and less costly than enoxaparin for treating acute coronary syndrome without ST-segment elevation (ACSWSTE). This anticoagulant therapy reduces cardiovascular events and major bleeding, offering a superior treatment option.
Area of Science:
- Cardiology
- Health Economics
- Pharmacoeconomics
Background:
- Acute coronary syndrome without ST-segment elevation (ACSWSTE) management involves antithrombotic and antiplatelet agents.
- Fondaparinux and enoxaparin are used, with fondaparinux showing similar efficacy to enoxaparin but with reduced bleeding risk.
Purpose of the Study:
- To evaluate the cost-effectiveness of fondaparinux versus enoxaparin for ACSWSTE patients in Brazil.
- Analysis from the perspective of the Brazilian Unified Health System (SUS).
Main Methods:
- A decision analytic model was employed to assess costs and outcomes.
- Data sourced from the OASIS-5 study (20,078 patients).
- Outcomes included cardiovascular events and major bleeding at 9, 30, and 180 days; direct costs were evaluated in 2010 Brazilian reais.
Main Results:
- Fondaparinux treatment cost R$ 2,768 vs. R$ 2,852 for enoxaparin per patient on day 9.
- Cardiovascular events and major bleeding rates were 7.3% for fondaparinux and 9.0% for enoxaparin.
- Invasive treatments constituted ~80% of total costs; drug costs were ~10%.
Conclusions:
- Fondaparinux is a superior treatment for ACSWSTE compared to enoxaparin.
- It offers better prevention of cardiovascular events at a lower overall cost.
Background:
The combined use of antithrombotic agents, antiplatelet agents and invasive strategies in acute coronary syndrome without ST-segment elevation (ACSWSTE) reduces cardiovascular events. Fondaparinux has demonstrated equivalence to enoxaparin in reducing cardiovascular events, but with a lower rate of bleeding in patients using fondaparinux.
Objective:
Evaluate the cost-effectiveness of fondaparinux versus enoxaparin in patients with ACSWSTE in Brazil from the economic perspective of the Brazilian Unified Health System (SUS).
Methods:
A decision analytic model was constructed to calculate the costs and consequences of the compared treatments. The model parameters were obtained from the OASIS-5 study (N = 20,078 patients with ACSWSTE randomized to fondaparinux or enoxaparin). The target outcome consisted of cardiovascular events (i.e., death, myocardial infarction, refractory ischemia and major bleeding) on days 9, 30 and 180 after ACSWSTE. We evaluated all direct costs of treatment and ACSWSTE-related events. The year of the analysis was 2010 and the costs were described in reais (R$).
Results:
On day 9, the cost of treatment per patient was R$ 2,768 for fondaparinux and R$ 2,852 for enoxaparin. Approximately 80% of total costs were associated with invasive treatments. The drug costs accounted for 10% of the total cost. The combined rates of cardiovascular events and major bleeding were 7.3% and 9.0% for fondaparinux and enoxaparin, respectively. Sensitivity analyses confirmed the initial results of the model.
Conclusion:
The use of fondaparinux for the treatment of patients with ACSWSTE is superior to that of enoxaparin in terms of prevention of further cardiovascular events at lower cost.
Related Concept Videos
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:30Anticoagulant Drugs: Low-Molecular-Weight Heparins
01:30Acute Coronary Syndrome I: Introduction
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:20Antiplatelet Drugs: Prostaglandin Synthesis, P2Y12 and Glycoprotein IIb/IIIa Inhibitors
Prostaglandin synthesis inhibitors, exemplified by the widely known aspirin, wield their power by irreversibly acetylating...
01:26Acute Coronary Syndrome V: Nursing Management