Open access · Peer reviewed · Scopus journal
Cost-effectiveness and Side Effects of Using Heparin and Enoxaparin as a Treatment for COVID-19-associated Coagulopathy
- 1,4,
- 2,7*,
- 2,3,
- 5,
- 6,
- 1,2,3
- 1Faculty of Medicine, Master Program of Basic Medical Science, Airlangga University, Surabaya, Indonesia.
- 2Pharmacology Department, Faculty of Medicine, Airlangga University, Surabaya, Indonesia.
- 3Anatomy and Histology Department, Faculty of Medicine, Airlangga University, Surabaya, Indonesia.
- 4Faculty of Medicine, Hasanuddin University, Makassar, Indonesia.
- 5Anesthesiology and Reanimation Department, Faculty of Medicine, Airlangga University, Surabaya, Indonesia.
- 6Cardiology and Vascular Medicine Departement, Airlangga University, Soetomo General Hospital, Surabaya, Indonesia.
- 7Department of Health Science, University Medical Center Groningen, University of Groningen, The Netherlands.
Published in Journal of Pharmacology and Pharmacotherapeutics
Correspondence: Abdul Khairul Rizki Purba
Pharmacology Department, Faculty of Medicine, Airlangga University, Surabaya, Indonesia.; Department of Health Science, University Medical Center Groningen, University of Groningen, The Netherlands.
Email: khairul_purba@fk.unair.ac.id
Copyright: © 2023 The Author(s). This is an open access article.
Published: Jan 1, 2023, Received: Sep 22, 2023, Accepted: Oct 30, 2023
Abstract
Objective: To analyze the cost-effectiveness and side effects of Heparin and Enoxaparin anti-coagulant in patients with COVID-19-associated coagulopathy (CAC).
Materials and Methods: This was an observational study with a retrospective design of CAC patients from May 2020 to May 2022 in Surabaya, Indonesia, who received Heparin and Enoxaparin. Effectiveness was comprehensively evaluated as clinical outcomes including mortality, length of stay (LOS), laboratory results, and side effects. Pharmacoeconomic evaluation was analyzed by constructing Decision Tree modeling followed by Cost-Effectiveness Analysis (CEA) considering Quality-Adjusted Life Year (QALY), and Incremental Cost-Effectiveness Ratio (ICER). In addition, probability sensitivity analysis was performed to consider the cost-effective intervention.
Results: A number of 274 samples were included from Medical Records and finance reports. Heparin has a higher mortality rate compared to Enoxaparin (13.9% vs. 23.9; p = 0.040), with no difference in the side effects (p = 0.056). D-Dimer reported a significant change in values after receiving Heparin (2271.01 ± 4595.50 ng/mL) and Enoxaparin (2140.95 ± 5681.98 ng/mL), p = 0.019. Enoxaparin was more cost-effective in pharmacoeconomic analysis, with a US$130.58/QALY ACER value, while Heparin was US$138.67/QALY.
Conclusion: Enoxaparin therapy has better effectiveness, while side effects and costs are similar to Heparin. However, Enoxaparin is far more cost-effective to use against CAC conditions than Heparin.
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