How to Evaluate Pharmacoeconomic Data: The Example of Enoxaparin in Acute Coronary Syndromes
Bibliographic record
Abstract
ABSTRACT The purpose of this article is to help pharmacists understand the process by which they should evaluate new drugs for inclusion in the formulary, specifically for determining whether the benefit is worth the risk and cost. A cost-effectiveness evaluation of enoxaparin for the treatment of acute coronary syndromes is used as an example. The ESSENCE trial demonstrated that the risk for the composite endpoint of death, myocardial infarction or recurrent angina in patients presenting with unstable angina or non-Q-wave myocardial infarction was lower, for up to 1 year after the index event, among patients treated with enoxaparin than among those who received standard heparin therapy. A pharmacoeconomic study for the Canadian population of the ESSENCE trial showed that treatment with enoxaparin resulted in an annual cost saving of approximately $1,485 per patient treated. A critical appraisal of these 2 studies demonstrates that both were well designed and valid and that their results should be taken into consideration for current clinical practice. RESUME L’objectif de cet article est d’aider les pharmaciens a comprendre la demarche qu’ils devraient suivre pour evaluer l’inscription d’un nouveau medicament au formulaire, plus particulierement pour determiner si l’avantage l’emporte sur le risque et le cout. Une analyse cout-efficacite de l’enoxaparine dans le traitement des syndromes coronariens aigus a ete utilisee a titre d’exemple. L’essai ESSENCE a demontre que le risque combine de mortalite globale, d’infarctus du myocarde ou d’angine recidivante chez les patients souffrant d’angine instable ou d’infarctus du myocarde sans onde Q etait plus faible chez les patients traites a l’enoxaparine que chez ceux ayant recu de l’heparine standard, et ce, jusqu’a une annee apres l’evenement indicateur. Une etude pharmacoeconomique de la population canadienne de l’essai ESSENCE a montre que le traitement a l’enoxaparine avait entraine des economies annuelles d’environ 1 485 $ par patient traite. Une evaluation critique de ces deux etudes a demontre leur rigueur et leur validite et que leurs resultats devraient etre consideres dans la pratique clinique actuelle.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.153 | 0.330 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.003 | 0.003 |
| Bibliometrics | 0.008 | 0.006 |
| Science and technology studies | 0.002 | 0.005 |
| Scholarly communication | 0.013 | 0.010 |
| Open science | 0.002 | 0.003 |
| Research integrity | 0.004 | 0.010 |
| Insufficient payload (model declined to judge) | 0.005 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".