Cost Effectiveness Analysis of Anticoagulants as The Therapy of Corona Virus Disease 19 (Covid-19)

Andy Kurniawan Saputra; Tri Murti Andayani; Ika Trisnawati

doi:10.22146/farmaseutik.v20i4.86807

Cost Effectiveness Analysis of Anticoagulants as The Therapy of Corona Virus Disease 19 (Covid-19)

https://doi.org/10.22146/farmaseutik.v20i4.86807

Andy Kurniawan Saputra^(1*), Tri Murti Andayani⁽²⁾, Ika Trisnawati⁽³⁾

(1) Magister of Clinical Pharmacy, Faculty of Pharmacy, Universitas Gadjah Mada
(2) Departement of Clinical Pharmacy and Pharmacology, Faculty of Pharmacy, Universitas Gadjah Mada
(3) Departement of Internal Disease, Dr Sardjito General Hospital
(*) Corresponding Author

Abstract

Hypercoagulation is a condition characterized by increased thrombosis and is caused by various factors, one of which is SARS-CoV-2 virus infection. Anticoagulants are the main therapeutic options such as heparin and enoxaparin. The administration of these two drugs can reduce coagulation parameters such as D-dimer, PT, and fibrinogen values. The purpose of this study was to analyze the cost-effectiveness comparison of heparin and enoxaparin as anticoagulants in severe and critical COVID-19 patients. This study is an analytical observational study with a retrospective cohort design from a provider perspective. The research subjects were severe and critical COVID-19 patients who met the inclusion and exclusion criteria at Dr. Sardjito General Hospital in the period January 2021 - January 2022. The effectiveness of anticoagulants was seen through a decrease in the D-dimer value to a value of < 500 ug/ml on day 14 in medical records, safety was assessed from the incidence of bleeding recorded in medical records, while the average direct cost data during the patient's hospitalization was studied to determine cost-effectiveness with the Incremental Cost-Effectiveness Ratio (ICER). The achievement of D-dimer value < 500 μg/ml for the heparin group was 39.5% while the enoxaparin group was 48.4%, the result showed no significant difference (p=0.293). All subjects did not experience bleeding. The average direct medical cost of the heparin group was Rp. 31,296,577 and enoxaparin was Rp. 55,205,810. The ACER calculation of heparin and enoxaparin was Rp. 79,233,841 and Rp. 114,061,591 with an ICER of Rp. 2,686,431 for a decrease in D-dimer value reaching < 500 ug/ml. This shows that enoxaparin is better at reducing D-dimer values despite having a higher cost than heparin.

Keywords

anticoagulant; cost-effectiveness; enoxaparin; heparin; COVID-19

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References

Abate, B. B., Kassie, A. M., Kassaw, M. W., Aragie, T. G., & Masresha, S. A. (2020). Sex difference in coronavirus disease (COVID-19): A systematic review and meta-analysis. BMJ Open, 10(10), e040129. https://doi.org/10.1136/bmjopen-2020-040129

Al Sulaiman, K., Aljuhani, O., Korayem, G. B., Hafiz, A., Alalawi, M., Badreldin, H. A., Altebainawi, A. F., Vishwakarma, R., Alissa, A., Alghamdi, A., Alenazi, A. A., Al Enazi, H., Alanazi, S., Alhammad, A., Alghamdi, J., AlFaifi, M., Al Sehli, F. A., Aldossari, M. A., Alhubaishi, A. A., … Al-Dorzi, H. M. (2022). Standard dosing of enoxaparin versus unfractionated heparin in critically ill patient with COVID-19: A multicenter propensity-score matched study. Thrombosis Journal, 20(1), 74. https://doi.org/10.1186/s12959-022-00432-9

Alqubbanchi, F. B., & Al-Hamadani, F. Y. (2021). A Pharmacoeconomics Study for Anticoagulants used for Hospitalized COVID-19 Patients in Al-Najaf Al-Ashraf city –Iraq(Conference Paper )#. Iraqi Journal of Pharmaceutical Sciences (IJPS), 30(Suppl.), 48–59. https://doi.org/10.31351/vol30issSuppl.pp48-59

Billett, H. H., Reyes-Gil, M., Szymanski, J., Ikemura, K., Stahl, L. R., Lo, Y., Rahman, S., Gonzalez-Lugo, J. D., Kushnir, M., Barouqa, M., Golestaneh, L., & Bellin, E. (2020). Anticoagulation in COVID-19: Effect of Enoxaparin, Heparin, and Apixaban on Mortality. Thrombosis and Haemostasis, 120(12), 1691–1699. https://doi.org/10.1055/s-0040-1720978

Elliott, J., Whitaker, M., Bodinier, B., Eales, O., Riley, S., Ward, H., Cooke, G., Darzi, A., Chadeau-Hyam, M., & Elliott, P. (2021). Predictive symptoms for COVID-19 in the community: REACT-1 study of over 1 million people. PLOS Medicine, 18(9), e1003777. https://doi.org/10.1371/journal.pmed.1003777

Fahmia, R., Helda, H., & Nursari, A. Y. (2022). Lama Rawat Inap Pasien Terkonfirmasi COVID-19 di Rumah Sakit Universitas Indonesia dan Faktor yang Mempengaruhinya. Jurnal Epidemiologi Kesehatan Indonesia, 6(1), Article 1. https://doi.org/10.7454/epidkes.v6i1.5004

Henry, B. M., de Oliveira, M. H. S., Benoit, S., Plebani, M., & Lippi, G. (2020). Hematologic, biochemical and immune biomarker abnormalities associated with severe illness and mortality in coronavirus disease 2019 (COVID-19): A meta-analysis. Clinical Chemistry and Laboratory Medicine, 58(7), 1021–1028. https://doi.org/10.1515/cclm-2020-0369

Lemos, A. C. B., do Espírito Santo, D. A., Salvetti, M. C., Gilio, R. N., Agra, L. B., Pazin-Filho, A., & Miranda, C. H. (2020). Therapeutic versus prophylactic anticoagulation for severe COVID-19: A randomized phase II clinical trial (HESACOVID). Thrombosis Research, 196, 359–366. https://doi.org/10.1016/j.thromres.2020.09.026

Loo, J., Spittle, D. A., & Newnham, M. (2021). COVID-19, immunothrombosis and venous thromboembolism: Biological mechanisms. Thorax, 76(4), 412–420. https://doi.org/10.1136/thoraxjnl-2020-216243

Maldonado, E., Tao, D., & Mackey, K. (2020). Antithrombotic Therapies in COVID-19 Disease: A Systematic Review. Journal of General Internal Medicine, 35(9), 2698–2706. https://doi.org/10.1007/s11606-020-05906-y

Marik, P. E., DePerrior, S. E., Ahmad, Q., & Dodani, S. (2021). Gender‐based disparities in COVID-19 patient outcomes. Journal of Investigative Medicine, 69(4), 814–818. https://doi.org/10.1136/jim-2020-001641

Oliynyk, O., Barg, W., Slifirczyk, A., Oliynyk, Y., Dubrov, S., Gurianov, V., & Rorat, M. (2021). Comparison of the Effect of Unfractionated Heparin and Enoxaparin Sodium at Different Doses on the Course of COVID-19-Associated Coagulopathy. Life, 11(10), Article 10. https://doi.org/10.3390/life11101032

Pawlowski, C., Venkatakrishnan, A., Kirkup, C., Berner, G., Puranik, A., O’Horo, J. C., Badley, A. D., & Soundararajan, V. (2021). Enoxaparin is associated with lower rates of mortality than unfractionated Heparin in hospitalized COVID-19 patients. EClinicalMedicine, 33, 100774. https://doi.org/10.1016/j.eclinm.2021.100774

Sholzberg, M., Tang, G. H., Rahhal, H., AlHamzah, M., Kreuziger, L. B., Áinle, F. N., Alomran, F., Alayed, K., Alsheef, M., AlSumait, F., Pompilio, C. E., Sperlich, C., Tangri, S., Tang, T., Jaksa, P., Suryanarayan, D., Almarshoodi, M., Castellucci, L. A., James, P. D., … Jüni, P. (2021). Effectiveness of therapeutic heparin versus prophylactic heparin on death, mechanical ventilation, or intensive care unit admission in moderately ill patients with covid-19 admitted to hospital: RAPID randomised clinical trial. BMJ, n2400. https://doi.org/10.1136/bmj.n2400

Singh, R., Rathore, S. S., Khan, H., Karale, S., Chawla, Y., Iqbal, K., Bhurwal, A., Tekin, A., Jain, N., Mehra, I., Anand, S., Reddy, S., Sharma, N., Sidhu, G. S., Panagopoulos, A., Pattan, V., Kashyap, R., & Bansal, V. (2022). Association of Obesity With COVID-19 Severity and Mortality: An Updated Systemic Review, Meta-Analysis, and Meta-Regression. Frontiers in Endocrinology, 13, 780872. https://doi.org/10.3389/fendo.2022.780872

Starke, K. R., Reissig, D., Petereit-Haack, G., Schmauder, S., Nienhaus, A., & Seidler, A. (2021). The isolated effect of age on the risk of COVID-19 severe outcomes: A systematic review with meta-analysis. BMJ Global Health, 6(12), e006434. https://doi.org/10.1136/bmjgh-2021-006434

Sujalmo, P., Purwanto, R. Y., Rismawanti, R. I., Pratama, Y. Y., Lalitya, W., & Fachrudin, A. B. (2023). Study of Survival of COVID19 Patients with Severe or Critical Symptoms: Study of D-dimer on Survival of COVID19 Patients with Severe or Critical Degrees in ICU COVID, Academic Hospital, Gadjah Mada University, Yogyakarta. Academic Hospital Journal, 4(1), Article 1.

Tal, S., Spectre, G., Kornowski, R., & Perl, L. (2020). Venous Thromboembolism Complicated with COVID-19: What Do We Know So Far? Acta Haematologica, 143(5), 417–424. https://doi.org/10.1159/000508233

Xie, J., Tong, Z., Guan, X., Du, B., & Qiu, H. (2020). Clinical Characteristics of Patients Who Died of Coronavirus Disease 2019 in China. JAMA Network Open, 3(4), e205619. https://doi.org/10.1001/jamanetworkopen.2020.5619

Yang, J., Tian, C., Chen, Y., Zhu, C., Chi, H., & Li, J. (2021). Obesity aggravates COVID-19: An updated systematic review and meta-analysis. Journal of Medical Virology, 93(5), 2662–2674. https://doi.org/10.1002/jmv.26677

DOI: https://doi.org/10.22146/farmaseutik.v20i4.86807