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Am Fam Physician. 1998;58(6):1435-1436

A 16 percent reduction in the 14-day incidence of death, myocardial infarction or recurrent angina was reported with the use of enoxaparin as compared with unfractionated heparin in the Efficacy and Safety of Subcutaneous Enoxaparin in Non–Q wave Coronary Events (ESSENCE) study. Mark and associates conducted a prospective, detailed economic analysis of the study findings.

Hospital billing data were available for 655 of the 936 patients in the ESSENCE study. During initial enrollment in the study, fewer major medical resources were used in the patients receiving enoxaparin compared with those receiving heparin. The greatest effect was a 5 percent absolute reduction in the use of coronary angioplasty. Trends for diagnostic catheterization and coronary bypass surgery favored enoxaparin but were not statistically significant. The duration of stay in the intensive care unit and the total length of hospitalization were shorter in patients receiving enoxaparin than in those receiving heparin, but the difference was not statistically significant.

At the 30-day follow-up, the differences between the two groups in resource use were equivalent to those seen at baseline or increased slightly in favor of enoxaparin. Reductions in the use of diagnostic catheterization (57 percent versus 63 percent for heparin) and coronary angioplasty (18 percent versus 22 percent for heparin) with enoxaparin were accompanied by a reduction in length of stay in the intensive care unit. The 30-day rehospitalization rate was 14 percent in the enoxaparin group and 16 percent in the heparin group.

While enoxaparin therapy costs almost twice as much as heparin therapy ($155 versus $80), the differences in resource consumption produced a $600 savings in hospital costs and a $237 savings in physician fees in the enoxaparin group. The total medical cost for the initial hospitalization was $11,857 for the enoxaparin group and $12,620 for the heparin group, resulting in a $763 savings with enoxaparin therapy. At the end of 30 days, the trends in cost figures that favored enoxaparin were all statistically significant. The total cumulative savings associated with enoxaparin at 30 days was $1,172.

The authors conclude that enoxaparin is among a select group of therapies that improves important clinical outcomes and reduces net treatment costs relative to traditional therapy. The most substantial reduction in resource use with enoxaparin was decreased use of coronary angioplasty, a consequence of the reduction in recurrent ischemic events.

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Copyright © 1998 by the American Academy of Family Physicians.

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