Outpatient treatment of venous thromboembolism with low-molecular-weight heparin: an economic evaluation.
BACKGROUND
The development of low-molecular-weight heparins (LMWHs) has made it possible to shift treatment of deep vein thrombosis (DVT) from inpatient to outpatient settings, thereby saving costs and improving patient quality of life.


OBJECTIVE
To quantify the economic benefits of early discharge of patients treated for DVT with LMWH using data pooled from multiple healthcare plans.


METHODS
Data sources were integrated medical and pharmacy claims paid by 37 US health plans (the PharMetrics Integrated Outcomes Database, PharMetrics, Inc., Watertown, MA). Hospitalized patients discharged with a diagnosis of DVT were selected and grouped according to the anticoagulation therapy they received after discharge. Outcomes and costs of DVT treatment were assessed over a 1-year period.


RESULTS
Patients discharged on the LMWH enoxaparin and warfarin spent 2.6 fewer days in the hospital than those discharged on warfarin alone (P< .0001), resulting in cost savings of $1911 per patient. Mean costs of outpatient management of DVT, including pharmacy and medical services, were $901 higher in the enoxaparin/warfarin cohort, but rate of readmission was lower (6.7% versus 9.0%; P < .05) and hence subsequent inpatient costs were reduced by $140 per patient. Total cost savings in the enoxaparin/warfarin cohort, net of higher outpatient costs, were $1151 per patient.


CONCLUSIONS
Outpatient anticoagulation therapy for DVT with enoxaparin and warfarin is associated with earlier hospital discharge, fewer readmissions, and lower total DVT-related costs compared with warfarin monotherapy.
Huse
Daniel M
DM
PharMetrics, Inc., Watertown, MA 02472, USA.
Cummins
Gordon
G
Taylor
Douglas C A
DC
Russell
Mason W
MW
D000368:Aged; D000553:Ambulatory Care / Q000191:economics; D000925:Anticoagulants / Q000191:economics* / Q000627:therapeutic use*; D017046:Cost Savings; D017281:Cost of Illness; D016527:Drug Costs; D017850:Economics, Pharmaceutical; D005260:Female; D017048:Health Care Costs; D006495:Heparin, Low-Molecular-Weight / Q000191:economics* / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013923:Thromboembolism / Q000188:drug therapy / Q000191:economics; D016896:Treatment Outcome; D014481:United States; D020246:Venous Thrombosis / Q000188:drug therapy* / Q000191:economics*; D014859:Warfarin / Q000191:economics* / Q000627:therapeutic use*
D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D014859:Warfarin