Analysis of Wholesale Drug Acquisition and Laboratory Assessment Costs Between Heparin Compared With Bivalirudin-Based Systemic Anticoagulation Strategies in Adult Extracorporeal Membrane Oxygenation
Authors' conclusion
Antithrombin assays and supplementation compromise a significant proportion of heparin-based anticoagulation costs in ECMO patients and is substantially reduced when a bivalirudin-based anticoagulation strategy is deployed.
Study context
- Population
- Adults on extracorporeal membrane oxygenation (ECMO) receiving heparin or bivalirudin for primary maintenance systemic anticoagulation, large academic ECMO center
- Participants
- 126 vs 275
- Exposure
- Heparin vs bivalirudin-based systemic anticoagulation for ECMO
- Pretransitionn = 126reference
- Posttransitionn = 275
- Outcome
- Costs per ECMO day
Methodological detailssingle-centre, Drug costs estimated using wholesale acquisition cost; laboratory assay costs using reimbursement fee schedules; normalized to ECMO run duration
- Single-centre
- Drug costs estimated using wholesale acquisition cost; laboratory assay costs using reimbursement fee schedules; normalized to ECMO run duration
Main finding
As reported in the abstract
- AT assay costs per ECMO day: $11.78 [IQR $9.48-$13.09] vs $1.03 [IQR $0-$5.75] (pre vs post)
- p < 0.0001
- AT supplementation costs per ECMO day: $0 [IQR $0-$312.82] vs $0 [IQR $0-$0] (pre vs post)
- p < 0.0001
Observational data: associations, not effects.
Further findings
Unadjusted survival · 28 days · unadjusted
P = 0.0286
AT supplementation
- Bivalirudin patients less likely to receive AT supplementation: 31.0 vs 12.4%
- P < 0.0001
Coagulation assays ordered per ECMO day
- Fewer coagulation assays: 6.1 vs 5.4 per ECMO day
- P = 0.0004
Parts of this Brief are withheld: the automatic checks could not confirm them against the abstract.
Original publication
Analysis of Wholesale Drug Acquisition and Laboratory Assessment Costs Between Heparin Compared With Bivalirudin-Based Systemic Anticoagulation Strategies in Adult Extracorporeal Membrane Oxygenation. Crit Care Med. Published 28 February 2023. doi:10.
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