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Fondaparinux versus Enoxaparin in non-ST-elevation acute coronary syndromes: Short-term cost and long-term cost-effectiveness using data from the Fifth Organization to Assess Strategies in Acute Ischemic Syndromes Investigators (OASIS-5) trialc

Research output: Contribution to journalArticle


  • Mark J. Sculpher
  • Greta Lozano-Ortega
  • Jennifer Sambrook
  • Stephen Palmer
  • Orges Ormanidhi
  • Ameet Bakhai
  • Marcus Flather
  • P. Gabriel Steg
  • Shamir R. Mehta
  • William Weintraub


Publication details

JournalAmerican Heart Journal
DatePublished - May 2009
Issue number5
Number of pages8
Pages (from-to)845-852
Original languageEnglish


Background The study aimed to compare the short-term costs and long-term cost-effectiveness of 2 antithrombotics, fondaparinux and enoxaparin, for non-ST-elevation acute coronary syndrome in the United States.

Methods It was based on a large randomized trial of 20,078 patients Fifth Organization to Assess Strategies in Acute Ischemic Syndromes Investigators [OASIS-5] comparing the therapies in these patients. In OASIS-5, fondaparinux patients had about half the rate of major bleeding 9 days after randomization and at least as good clinical outcomes (death, myocardial infarction, major bleeding and stroke) after 6 months of follow-up. Health care resource use and clinical efficacy data from the trial were incorporated into a cost-effectiveness model as applied to a general US health care system both for the time horizon of the study (6 months) and over the longer term.

Results The 180-day cost analysis indicates that fondaparinux would generate a cost saving of $547 per patient (95% CI $207-$924). Sensitivity analysis suggested that savings could vary between $494 and $733. When 180-day cost and clinical results were extrapolated to long-term cost-effectiveness, fondaparinux was dominant (less costly and more effective in terms of quality-adjusted life-years) under most scenarios.

Conclusions Fondaparinux is a more cost-effective antithrombotic agent than enoxaparin in non-ST-elevation acute coronary syndrome. This is true across the range of event risks seen in OASIS-5. (Am Heart J 2009; 157:845-52.)

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