While we found relatively good st and ards of reporting the study ’s question , population , interventions , comparators and conclusions , the overall reporting was poor , and evidence of unfamiliarity with international guidelines was evident ( i.e. absence of incremental analysis , of discounting long-term costs and effects ) .
Analysis or description of place-to-place variability was infrequent .
Use and acceptance of health economic evaluations ( HEEs ) has been much greater in developed than in developing nations .
Nevertheless , while developing countries lag behind in the development of HEE methods , they could benefit from the progress made in other countries and concentrate on ways in which existing methods can be used or would need to be modified to fulfill their specific needs .
HEEs , as context -specific tools , are not easily generalizable from setting to setting .
Existing studies regarding generalizability and transferability of HEEs have primarily been conducted in developed countries .
Therefore , a legitimate question for policy makers in Latin America and the Caribbean region ( LAC ) is to what extent HEEs conducted in industrialized economies and in LAC are generalizable to LAC ( trans-regional ) and to other LAC countries ( intra-regional ) , respectively .
Will the use of low-molecular-weight heparin (enoxaparin) in patients with acute coronary syndrome save costs in Canada?
BACKGROUND One-year follow-up data from the Efficacy and Safety of Subcutaneous Enoxaparin in Non-Q-Wave Coronary Events ( ESSENCE ) trial show that use of low-molecular-weight heparin ( enoxaparin ) compared with unfractionated heparin in patients hospitalized with unstable angina or non-Q-wave myocardial infa rct ion is associated with a 10 % reduction in the cumulative 1-year risk of death , myocardial infa rct ion , or recurrent angina . Given the higher acquisition cost of enoxaparin relative to unfractionated heparin , we assessed whether the reduced use of revascularization procedures and related care makes enoxaparin a cost-saving therapy in Canada . METHODS AND RESULTS We analyzed cumulative 1-year re source use data on the 1259 ESSENCE patients enrolled in Canadian centers ( 40 % of the total ESSENCE sample ) . Patient-specific data on use of drugs , diagnostic cardiac catheterization , percutaneous transluminal coronary angioplasty , coronary artery bypass grafting , and hospital days were available from the initial hospital stay and cumulative to 1 year . Hospital re sources were costed with the use of data from a teaching hospital in southern Ontario that is a participant in the Ontario Case Costing Project . During the initial hospital stay , use of enoxaparin was associated with reduced use of diagnostic catheterization and revascularization procedures , with the largest effect being reduced use of percutaneous transluminal coronary angioplasty ( 15.0 % vs 10.6 % ; P = .03 ) . At 1 year , the reduced risk and costs of revascularization more than offset increased drug costs for enoxaparin , producing a cost-saving per patient of $ 1485 ( 95 % confidence interval $ -93 to $ 3167 ; P = .06 ) . Sensitivity analysis with lower hospital per diem costs from a community hospital in Ontario still predicts cost savings of $ 1075 per patient over a period of 1 year . CONCLUSIONS The acquisition and administration cost of enoxaparin is higher than for unfractionated heparin ( $ 101 vs $ 39 ) , but in patients with acute coronary syndrome , the reduced need for hospitalization and revascularization over a period of 1 year more than offsets this initial difference in cost . Evidence from this Canadian sub study of ESSENCE supports the view that enoxaparin is less costly and more effective than unfractionated heparin in this indication
While we found relatively good st and ards of reporting the study ’s question , population , interventions , comparators and conclusions , the overall reporting was poor , and evidence of unfamiliarity with international guidelines was evident ( i.e. absence of incremental analysis , of discounting long-term costs and effects ) .
Analysis or description of place-to-place variability was infrequent .
Use and acceptance of health economic evaluations ( HEEs ) has been much greater in developed than in developing nations .
Nevertheless , while developing countries lag behind in the development of HEE methods , they could benefit from the progress made in other countries and concentrate on ways in which existing methods can be used or would need to be modified to fulfill their specific needs .
HEEs , as context -specific tools , are not easily generalizable from setting to setting .
Existing studies regarding generalizability and transferability of HEEs have primarily been conducted in developed countries .
Therefore , a legitimate question for policy makers in Latin America and the Caribbean region ( LAC ) is to what extent HEEs conducted in industrialized economies and in LAC are generalizable to LAC ( trans-regional ) and to other LAC countries ( intra-regional ) , respectively .