Cost-effectiveness analysis for the parenteral anticoagulants in Jordan

Objectives Pharmacoeconomic dimensions linking clinical effectiveness of parenteral anticoagulants for management of acute venous thromboembolism (VTE) and cost of treatment are needed to support choices by healthcare providers. The objective of the study was to conduct a cost-effectiveness analysis for 5-day treatment with parenteral anticoagulants in Jordan. Methods Cost-effectiveness analysis was conducted based on decision analysis tree model. The perspective was the payer, considering direct medical costs. Probabilities of failure of treatment and major bleeding were derived from published clinical studies. Costs were estimated based on 2019 prices in Jordan. Key findings The average cost of VTE hospitalization and major bleeding management in Jordan were 2324.00 US$ and 3347.40 US$, respectively. Bemiparin was associated with the highest clinical efficacy and lowest probability of major bleeding. Nadroparin had the lowest clinical efficacy, while tinzaparin was found to have the highest risk of major bleeding. Bemiparin had the lowest average cost-effectiveness ratio (101.63 US$/success) and nadroparin had the highest cost-effectiveness ratio (295.56 US$/success). Throughout the sensitivity analysis calculations, bemiparin and nadroparin had the lowest and highest cost of treatment, respectively. Conclusions The cost of parenteral anticoagulant drugs, the same as many other drugs, does not always correlate with cost of VTE treatment. Other direct medical costs (e.g. treatment failure and management of bleeding) have a high contribution to the total cost calculation. Pharmacoeconomically, bemiparin is the dominant cost-effective parenteral anticoagulant in Jordan, while nadroparin is the dominated one.