Treatment of proximal vein thrombosis with subcutaneous low-molecular-weight heparin vs intravenous heparin. An economic perspective.
BACKGROUND
Subcutaneous low-molecular-weight heparin is at least as effective and safe as classic intravenous heparin therapy for the treatment of proximal vein thrombosis. Anticoagulant monitoring is not required with low-molecular-weight heparin.


OBJECTIVE
To perform an economic evaluation of these therapeutic approaches by comparing cost and effectiveness.


METHODS
A randomized trial in 432 patients with proximal vein thrombosis that compared intravenous heparin and low-molecular-weight heparin with objective documentation of clinical outcomes provided the opportunity to perform an analysis of cost-effectiveness to rank these alternative therapies in terms of both their cost and effectiveness. The economic viewpoint of this analysis was that of a third-party payer (ie, a ministry of health in Canada or an insurance company in the United States).


RESULTS
In the intravenous heparin-treated group, the cost incurred for 100 patients was $414,655 (Canadian dollars) or $375,836 (US dollars), with a frequency of objectively documented venous thromboembolism of 6.9%. In the low-molecular-weight heparin-treated group, the cost incurred for 100 patients was $399,403 (Canadian dollars) or $335,687 (US dollars), with a frequency of objectively documented venous thromboembolism of 2.8%, thus providing a cost saving of $15,252 (Canadian dollars) or $40,149 (US dollars). Multiple sensitivity analyses were performed, and these procedures did not alter the findings of the study.


CONCLUSIONS
The findings indicate that low-molecular-weight heparin therapy is at least as effective and safe but less costly than intravenous heparin treatment. The potential for outpatient therapy in up to 37% of patients who are receiving low-molecular-weight heparin would substantially augment the cost saving.
Hull
R D
RD
Clinical Trials Unit, University of Calgary, Alberta.
Raskob
G E
GE
Rosenbloom
D
D
Pineo
G F
GF
Lerner
R G
RG
Gafni
A
A
Trowbridge
A A
AA
Elliott
C G
CG
Green
D
D
Feinglass
J
J
D000925:Anticoagulants / Q000008:administration & dosage / Q000191:economics*; D015982:Bias; D002170:Canada; D003362:Cost-Benefit Analysis; D004334:Drug Administration Schedule; D006493:Heparin / Q000008:administration & dosage / Q000191:economics*; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage / Q000191:economics*; D006801:Humans; D007262:Infusions, Intravenous; D007279:Injections, Subcutaneous; D012680:Sensitivity and Specificity; D013923:Thromboembolism / Q000209:etiology / Q000517:prevention & control*; D013927:Thrombosis / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D014481:United States
D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D006493:Heparin