Deep venous thrombosis: a new task for primary health care. A randomised economic study of outpatient and inpatient treatment.
OBJECTIVE
A health economic evaluation of two alternative treatment settings, inpatient care and outpatient care, for acute deep venous thrombosis.


METHODS
A randomised multicentre trial in a defined population in regular clinical practice.


METHODS
Hospitals and related health care centres in the Jönköping county council in Sweden.


METHODS
Patients were randomised to either an inpatient strategy (n = 66) or an outpatient strategy (n = 65) using low-molecular-weight heparin, dalteparin, administered subcutaneously once daily and adjusted for body weight.


METHODS
Of 224 eligible patients, 131 entered the trial and 124 completed the economic part of the study.


METHODS
Direct medical and direct non-medical costs during a 3-month period.


RESULTS
Total direct costs were higher for those in the inpatient strategy group, i.e. Swedish Crowns (SEK) 16400 per patient (Euro 1899) compared to SEK 12100 per patient (Euro 1405) in the outpatient strategy group (p < 0.001). More patients in the outpatient group received assistance when they returned home. Few patients in either group reported sick leave. There was no difference in total number of days between the two groups.


CONCLUSIONS
Total direct costs were significantly lower for the outpatient treatment strategy for deep venous thrombosis compared to the inpatient treatment strategy. No significant difference in health impact could be detected. Deep venous thrombosis can to a greater extent than previously be treated in primary care, safely, at a lower cost, and in accordance with patient preferences.
Bäckman
Karin
K
Center for Medical Technology Assessment, Linköping University, Linköping, Sweden. karin.backman@lio.se
Carlsson
Per
P
Kentson
Magnus
M
Hansen
Sören
S
Engquist
Leif
L
Hallert
Claes
C
D000279:Administration, Cutaneous; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D017985:Dalteparin / Q000627:therapeutic use; D004180:Direct Service Costs / Q000706:statistics & numerical data; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D017721:Hospital Costs / Q000706:statistics & numerical data; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000191:economics*; D013548:Sweden; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000188:drug therapy* / Q000191:economics*
D000925:Anticoagulants; D017985:Dalteparin