US without SonoRx

no treatment (HIT I)

89.8%

$27,284

well

90.2%

new thrombosis

6.0%

early treatment (<48h)

35.4%

amputation

$35,441

3.2%

death

0.0%

argatroban treatment (HIT II)

stroke

10.2%

ischemic 0.6%

$41,271

hemorrhagic 0.0%

well

69.7%

delayed treatment (>=48h)

new thrombosis

64.6%

14.2%

$44,465

amputation

13.4%

death

1.6%

stroke

ischemic 1.1%

well

68.1%

new thrombosis

21.3%

discontinue heparin (HIT II)

10.2%

$38,046

amputation

2.4%

death

3.5%

stroke

S 27,284.42 S 31,737.26 S 62,627.53 S 85,744.29 S 57,887.71

32,107.57 54,927.77 73,222.47

55,298.08 73,592.78

S 28,045.11

S 58,935.38

S 82,052.14

S 54,195.56

Ischemic hemorrhagic

Ischemic hemorrhagic

S 27,284.42 S 31,737.26 S 62,627.53 S 85,744.29 S 57,887.71

32,107.57 54,927.77 73,222.47

55,298.08 73,592.78

S 28,045.11

S 58,935.38

S 82,052.14

S 54,195.56

Figure 24.4 The decision-analytic model shows the three strategies that were examined by Arnold and researchers [22] to evaluate the financial implications of the direct thrombin inhibitor argatroban for early treatment (< 48 hours after thrombocytopenia onset), compared with delayed treatment, of heparin-induced thrombocytopenia (HIT) with or without thrombosis.

treatment by the incremental effectiveness, or the cost per new thrombosis event avoided. The evaluation indicated that the mean cost per HIT patient without thrombosis decreased by 6.85% for patients who were treated earlier with argatroban therapy, representing a $2605 saving per patient compared with those not treated with argatroban. For those receiving delayed argatro-

ban therapy, the mean cost increased by $9024 per patient compared with those receiving early treatment with argatroban.

Another economic model was developed to allow members of a pharmaceutical company team to evaluate potential total costs of managing patients with mild-to-moderate hypertension who were treated with a variety of medications. The cost analysis evaluated the average total cost per evaluation period to initially and subsequently control blood pressure for each of the agents and an investigational agent. In this analysis, cost was calculated as the sum of the cost of treating hypertension during the evaluation period, costs of treating adverse drug events, and drug acquisition costs. Two analyses were completed with this model: (1) a consultant-based analysis, which consisted of a literature review and an advisory panel (three primary care practitioners and three cardiologists) survey, and (2) a pharmacy benefits management (PBM) database-dependent evaluation. In the second analysis, actual drug utilization data were obtained via linkage of medical claims and drug utilization data. The least expensive agent was the investigational agent in the consultant-based analysis, whereas it was a marketed drug in the PBM-based analysis. The likely primary reason for the different ranking between the analyses was the small number of patients in the PBM database with costly and resource-intensive adverse drug events reported by the consultants and the literature for the marketed drug. In addition, only clinical trial data were available for the investigational drug, which is not likely to correspond to a "real-world" setting.

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