Cost-minimization analysis of low-molecular-weight heparin (dalteparin) compared to unfractionated heparin for inpatient treatment of cancer patients with deep venous thrombosis.
OBJECTIVE
Low-molecular-weight heparin (LMWH) has shown to be as effective as unfractionated heparin (UFH) in the treatment of deep venous thrombosis (DVT). Although the acquisition cost of LMWH is significantly greater than that of UFH, we hypothesized that once-daily dalteparin, a LMWH, could reduce treatment costs of cancer patients with DVT by eliminating anticoagulation monitoring and shortening hospitalization.


METHODS
We developed a cost-minimization model by using outcomes and resource utilization data from two retrospective matched cohorts of cancer patients who, between 1994 and 1999, were hospitalized at our comprehensive cancer center for treatment of DVT with either LMWH ( n=21) or UFH ( n=168). We assumed all LMWHs and UFH to be equally effective. The total costs for the dalteparin strategy and the UFH strategy were calculated in year 2003 U.S. dollars, from the provider's perspective, by multiplying the number of resources used for inpatient treatment of DVT by their unit costs.


RESULTS
The mean total cost for inpatient care was $3,383 US dollars (95% CI= $2,683- $4,083) for dalteparin and $4,952 US dollars (95% CI=$4,718-$5,185) for UFH. Substantial savings resulted from shorter hospitalization among the dalteparin-treated patients (mean 3.19 versus 5.22 days). Sensitivity analysis did not change the conclusion that dalteparin is less expensive than UFH.


CONCLUSIONS
Savings realized from less anticoagulant monitoring and shorter hospitalization offset the higher acquisition cost of dalteparin. The dalteparin strategy is less expensive than the UFH strategy for the inpatient treatment of DVT among cancer patients.
Section of Health Services Research, Department of Biostatistics, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard-Unit 196, Houston, TX 77030-4009, USA. ecaramel@mdanderson.org
Elenir B C
EB
Avritscher
Scott B
SB
Cantor
Ya-Chen T
YC
Shih
Carmelita P
CP
Escalante
Edgardo
E
Rivera
Linda S
LS
Elting
D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D017985:Dalteparin / Q000191:economics* / Q000627:therapeutic use; D005260:Female; D005343:Fibrinolytic Agents / Q000191:economics* / Q000627:therapeutic use; D006493:Heparin / Q000191:economics* / Q000627:therapeutic use; D006495:Heparin, Low-Molecular-Weight / Q000191:economics; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D020246:Venous Thrombosis / Q000188:drug therapy / Q000191:economics*
D000925:Anticoagulants; D005343:Fibrinolytic Agents; D006495:Heparin, Low-Molecular-Weight; D006493:Heparin; D017985:Dalteparin