RESUMO
BACKGROUND: The Efficacy and Safety of Subcutaneous Enoxaparin in Non-Q-Wave Coronary Events (ESSENCE) and Thrombolysis in Myocardial Infarction (TIMI) 11B studies revealed that enoxaparin reduced the incidence of death, myocardial reinfarction and recurrent angina in patients with acute coronary syndrome (ACS) compared with unfractionated heparin (UFH). OBJECTIVE: To perform a pharmacoeconomic analysis to evaluate the cost effectiveness of treatment with enoxaparin compared with UFH in Spanish patients with ACS. DESIGN AND SETTING: Retrospective cost-effectiveness analysis using data and costs from Spanish sources, conducted from the perspective of the National Health System. PATIENTS, INTERVENTIONS AND OUTCOMES MEASURES: The study was based on the results of the ESSENCE and TIMI 11B clinical trials, which included more than 7,000 patients with ACS treated with enoxaparin or UFH. The main variables studied were the success rate, expressed as patients with no complications (reinfarction, unstable angina or death), and the decrease in the utilisation of healthcare resources (revascularisation procedures and hospitalisation). RESULTS: The base-case results of the analysis showed superior efficacy and lower total treatment and follow-up costs with enoxaparin compared with UFH. The total savings in direct health costs per patient with enoxaparin ranged between 448 and 659 euros (time horizons of 1 month and 1 year, respectively) [2001 values]. The sensitivity analysis results confirmed the advantage of enoxaparin in all cases, except in one scenario: when simultaneously using all the minimum values of the confidence interval for absolute risk reduction (ARR) in the utilisation of health resources. CONCLUSIONS: This study suggests that enoxaparin is a more effective and less expensive treatment option than UFH in secondary prevention of patients with ACS in Spain, confirming the results obtained in other pharmacoeconomic analyses performed in the UK, USA, France and Canada.