Authors' objectives:

This report considers the cost-utility of two low molecular weight heparins (LMWHs), dalteparin and enoxaparin, compared with unfractionated heparin (UFH) in the treatment of unstable angina and non-Q-wave myocardial infarction (MI).

Authors' recommendations: Low molecular weight heparins represent a promising class of drugs, with important advantages over unfractionated heparin in terms of convenience and time saved to patients and staff. However, the use of a composite outcome measure in trials of both drugs makes it impossible to draw a definite conclusion on the benefits of treatment, as the uncertainty around individual outcomes is consistent with no effect or even harm. The committee noted that dalteparin use was associated with an increased number of deaths in the FRIC trial, although the number of cases was small, and that minor haemorrhage rates were increased in the ESSENCE trial of enoxaparin. It was not clear whether the reduction in invasive coronary procedures (PTCA and CABG) would in practice result in realisable savings in the UK, given the small numbers involved in the trials and difficulties in applying results from overseas. The evidence in this area is evolving rapidly and the Committee asked for it to be kept under review.

Authors' methods: Review

Project Status: Completed

URL for project: http://www.wihrd.soton.ac.uk

Year Published: 1999

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: England

Organisation Name: Wessex Institute for Health Research and Development

Contact Address: Pauline King. Wessex Institute for Health Research and Development, Boldrewood Medical School, Bassett Crescent East, Highfield, Southampton. SO16 7PX Tel. +44 1703 595661 Fax +44 1703 595662

Copyright: Wessex Institute for Health Research and Development (WIHRD)