OBJECTIVES: Fondaparinux and low-molecular-weight heparins (LMWHs) are injectable anticoagulants for treatment or prevention of venous thromboembolic events (VTE; including deep-vein thrombosis and pulmonary embolism) and treatment of acute coronary syndrome (ACS). Fondaparinux is the only injectable anticoagulant which also has marketing authorization for treatment of superficial vein thrombosis. LMWHs are associated with a risk of heparin-induced thrombocytopaenia (HIT), a rare but serious adverse event, while fondaparinux has a negligible HIT risk. We model the cost savings and budget impact of fondaparinux versus LMWH.

METHODS: Our model estimates per-patient costs and budget impact of fondaparinux versus LMWHs (enoxaparin, nadroparin, tinzaparin, parnaparin) for treatment and prevention of VTE and treatment of ACS. Model inputs include incidence of VTE and ACS; market share of fondaparinux/LMWHs for each indication; drug costs; and HIT-associated costs.

RESULTS: Per-patient drug costs for fondaparinux and LMWHs vary between the markets analyzed. Management of HIT and HIT‑related complications is associated with costs of ~10,000 EUR which adds substantially to the per-patient cost of treatment/prevention using LMWH in all markets. In one of the markets analyzed, Italy, per-patient drug costs are lower for fondaparinux than LMWH. Avoidance of HIT-related costs resulted in per-patient cost savings with fondaparinux in Italy of between 76% for treatment of VTE, up to 96% for treatment of ACS. In the Italian analysis, the lower per-patient costs result in substantial budget savings which increase with a projected rise in fondaparinux market share over a 5-year period.

CONCLUSIONS: Avoidance of HIT-related costs results in cost-savings with fondaparinux compared with LMWH across all indications which can provide substantial budget savings. Further analysis will demonstrate potential cost savings with fondaparinux in other healthcare systems.