Cost-effectiveness analysis of alternative anticoagulation in suspected heparin-induced thrombocytopenia.

Tuleja, Aleksandra; Salvador, Dante; Muka, Taulant; Bernhard, Sarah; Lenz, Armando; Baumgartner, Iris; Schindewolf, Marc (2022). Cost-effectiveness analysis of alternative anticoagulation in suspected heparin-induced thrombocytopenia. Blood advances, 6(10), pp. 3114-3125. American Society of Hematology 10.1182/bloodadvances.2022007017

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Heparin-induced thrombocytopenia (HIT) is a life-threatening complication associated with high medical costs. Factor Xa inhibitors have gradually replace approved treatment with intravenous direct thrombin inhibitors despite their off-label indication, because of easier management and favorable economic profile.Whether they are cost-effective remains unclear. We evaluated the cost-effectiveness of approved and off-label anticoagulants in patients with suspected HIT, based on census data from the largest Swiss hospital between 2015 and 2018. We constructed a decision tree model that reflects important clinical events associated with HIT. Relevant cost data were obtained from the finance department or estimated based on the Swiss-wide cost tariff. We estimated averted adverse events (AE) and incremental cost-effectiveness ratio as primary outcome parameters. We performed deterministic and probabilistic sensitivity analyses with 2000 simulations to assess the robustness of our results. In the base-case analysis, the total cost of averting one AE was 49,565 CHF for argatroban; 30,380 CHF for fondaparinux, and 30,610 CHF for rivaroxaban; after adjusting for 4Ts score: 41,152 CHF (argatroban); 27,710 CHF (fondaparinux) and 37,699 CHF (rivaroxaban). Fondaparinux and rivaroxaban were more clinically-effective than argatroban with AE averted of 0.820; 0.834 and 0.917 for argatroban, fondaparinux and rivaroxaban, respectively. Treatment with fondaparinux resulted in less cost and more AE averted, hence dominating argatroban. Results were most sensitive to AE rates and prolongation of stay. Monte Carlo simulations affirmed our base-case analysis. This is the first cost-effectiveness analysis comparing argatroban with fondaparinux and rivaroxaban using primary data. Fondaparinux and rivaroxaban resulted in more averted AE but fondaparinux had greater cost savings. Fondaparinux could be a viable alternative to argatroban.

Item Type:

Journal Article (Original Article)


04 Faculty of Medicine > Pre-clinic Human Medicine > Department of Clinical Research (DCR)
04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine (ISPM)
04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Angiology

Graduate School:

Graduate School for Health Sciences (GHS)

UniBE Contributor:

Tuleja, Aleksandra Beata, Salvador, Dante Jr., Muka, Taulant, Bernhard, Sarah Maike, Lenz, Armando, Baumgartner, Iris, Schindewolf, Marc


300 Social sciences, sociology & anthropology > 360 Social problems & social services
600 Technology > 610 Medicine & health




American Society of Hematology




Andrea Flükiger-Flückiger

Date Deposited:

18 Feb 2022 11:45

Last Modified:

20 Feb 2024 14:16

Publisher DOI:


PubMed ID:





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