Cost-effectiveness and Side Effects of Using Heparin and Enoxaparin as a Treatment for COVID-19-associated Coagulopathy

Abstract

Objective: To analyze the cost-effectiveness and side effects of Heparin and Enoxaparin anti-coagulants 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.