Low-molecular-weight heparins compared with unfractionated heparin for treatment of acute deep venous thrombosis: A cost-effectiveness analysis

• Published in: Annals of internal medicine Vol. 130; no. 10; pp. 789 - 799
• Main Authors: GOULD, M. K, DEMBITZER, A. D, SANDERS, G. D, GARBER, A. M
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA American College of Physicians 18-05-1999
• Subjects: Anticoagulants - economics; Anticoagulants - therapeutic use; Biological and medical sciences; Blood. Blood coagulation. Reticuloendothelial system; Cost-Benefit Analysis; Decision Support Techniques; Heparin - economics; Heparin - therapeutic use; Heparin, Low-Molecular-Weight - economics; Heparin, Low-Molecular-Weight - therapeutic use; Hospital Costs; Humans; Life Expectancy; Male; Medical sciences; Middle Aged; Multivariate Analysis; Pharmacology. Drug treatments; Pulmonary Embolism - etiology; Quality-Adjusted Life Years; Randomized Controlled Trials as Topic; Recurrence; Sensitivity and Specificity; Venous Thrombosis - complications; Venous Thrombosis - drug therapy; Venous Thrombosis - economics; Human; Acute; Cardiovascular disease; Low molecular weight heparin; Male; Decision analysis; Thrombosis; Venous disease; Vascular disease; Chemotherapy; Treatment; Glycosaminoglycan; Deep vein; Heparin; Comparative study; Cost efficiency analysis
• ISSN: 0003-4819; 1539-3704
• DOI: 10.7326/0003-4819-130-10-199905180-00002

Low-molecular-weight heparins are effective for treating venous thrombosis, but their cost-effectiveness has not been rigorously assessed.
To evaluate the cost-effectiveness of low-molecular-weight heparins compared with unfractionated heparin for treatment of acute deep venous thrombosis.
Decision model.
Probabilities for clinical outcomes were obtained from a meta-analysis of randomized trials. Cost estimates were derived from Medicare reimbursement and other sources.
Two hypothetical cohorts of 60-year-old men with acute deep venous thrombosis.
Patient lifetime.
Societal.
Fixed-dose low-molecular-weight heparin or adjusted-dose unfractionated heparin.
Costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios. An in-patient hospital setting was used for the base-case analysis. Secondary analyses examined outpatient treatment with low-molecular-weight heparin.
Total costs for inpatient treatment were $26,516 for low-molecular-weight heparin and $26,361 for unfractionated heparin. The cost of initial care was higher in patients who received low-molecular-weight heparin, but this was partly offset by reduced costs for early complications. Low-molecular-weight heparin treatment increased quality-adjusted life expectancy by approximately 0.02 years. The incremental cost-effectiveness of inpatient low-molecular-weight heparin treatment was $7820 per QALY gained. Treatment with low-molecular-weight heparin was cost saving when as few as 8% of patients were treated at home.
When late complications were assumed to occur 25% less frequently in patients who received unfractionated heparin, the incremental cost-effectiveness ratio increased to almost $75,000 per QALY gained. When late complications were assumed to occur 25% less frequently in patients who received low-molecular-weight heparin, this treatment resulted in a net cost savings. Inpatient low-molecular-weight heparin treatment became cost saving when its pharmacy cost was reduced by 31% or more, when it reduced the yearly incidence of late complications by at least 7%, when as few as 8% of patients were treated entirely as outpatients, or when at least 13% of patients were eligible for early discharge.
Low-molecular-weight heparins are highly cost-effective for inpatient management of venous thrombosis. This treatment reduces costs when small numbers of patients are eligible for outpatient management.