Speaker
Description
Abstract
Background: The novel coronavirus 2 (SARS‐CoV‐2) pandemic poses a serious threat to public health and local economies around the globe. It is a pulmonary disease, but it also leads to cardiac, hematologic, and renal complications. Hematologic complications are represented by Thromboembolic events which occur in patients with COVID-19. Anticoagulants are used for COVID-19 infected patients because the infection increases the risk of thrombosis especially venous thromboembolism. Currently, the world health organization (WHO), recommend prophylaxis dose of anticoagulants: (Enoxaparin or unfractionated Heparin for hospitalized patients with COVID-19 disease. This has created an urgent need to identify effective medications for COVID-19 prevention and treatment. The value of COVID-19 treatments is affected by cost-effectiveness analysis (CEA) to inform relative value and how to best maximize social welfare through evidence-based pricing decisions.
Objective: The research aim was to compare the clinical outcome and the costs of two anticoagulant injections (unfractionated heparin and low molecular weight heparin (enoxaparin)) used to treat hospitalized patients with COVID-19 infection.
Patients and method:
The study was a single-center including retrospective review of medical records hospitalized patients at Al-amal Epidemiology Center, Al-Najaf city from (August 2020 to June 2021). Inclusion criteria: Hospitalized patients with COVID-19 infection, age > 18 years, non-pregnant, and received one of the injectable anticoagulants, for 3 days and more, with at least two measurements for the D-dimer (the first one before receiving the treatments and the second one at the last day of receiving the treatments). The outcome measures included D-dimer, length of stay (LOS), and mortality rate. Only the cost of the medical treatment (taken from a drug store which supplies Al-amal Epidemiology Center) was considered in the analysis.
The pharmacoeconomic analysis was done in three different methods, 1st one is by using the cost-effectiveness grid, 2nd by using the cost-effectiveness plane, 3rd method is incremental net benefit analysis (INB) which considers maximum willingness to pay as an effector on cost-effectiveness analysis. Statistical analysis: Microsoft Excel spreadsheet was used to collect and analyze the results. Statistical Package for the Social Sciences software (SPSS), was used to conduct statistical analysis. Kaplan Meier test was used to compare the mortality rate. T-TEST was used to compare the outcomes of the two groups.
Results: Medical records of -1100- hospitalized patients were reviewed, but only 144 records met the inclusion criteria, 72 patients received heparin, and 72 patients received enoxaparin. There was no difference in comorbidities between the two groups (P-value>0.05).
COVID-19 infected patients had a higher average D-dimer (2534.675 ng/dl) compared to the normal range (<499 ng/dl).
There were no significant differences between both genders with regards to the basal average D-dimer (males= 2649.95 ng/dl, females= 2374.1mg/dl, P-value>0.05). There was a significant difference between patient's age≥ 60 years and patients <60 with regards to basal average D-dimer. (3177.33 ng/dl, 1763.06 ng/dl, P-value <0.05). It seems that, higher D-dimer levels were associated with a higher mortality rate (died=3166.263 ng/dl, survived= 1729.94 ng/dl, P-value <0.05). Heparin was more effective in decreasing D-dimer levels than enoxaparin which inversely increased the D-dimer levels (-24.4 ng/dl/day, +154.701 ng/dl/day, P-value <0.05). Additionally, heparin was more effective in increasing the survival rate compared to enoxaparin (55% vs, 35%, P-value<0.05). Heparin was associated with a longer duration of stay in hospital than enoxaparin but the difference in the duration was not significant (13.7 days, 12.3 days, P-value >0.05).
Concerning the cost, treatment with heparin cost less than enoxaparin (2.08 U.S $, 9.44 U.S $)/per patient/per day.
Conclusion: Originator heparin was a more cost-effective anticoagulant therapy compared to originator enoxaparin, it was associated with a lower cost and better effect, treatment with Heparin resulted in positive INB= 11.3, where a positive result means that heparin is more cost-effective than Enoxaparin. All three methods of pharmacoeconomic analysis decide that heparin was more cost-effective than enoxaparin in treating COVID-19 infected patients.
Keywords: pharmacoeconomic, cost-effectiveness, COVID-19, anticoagulants, heparin, enoxaparin.
| Has the manuscript been published? | non published |
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| do you want to publish the Manuscript in ( Iraqi Journal of Pharmaceutical Sciences)? | Yes |
