An economic evaluation of the costs and benefits of heparin rationalisation in a hospital pharmacy.
OBJECTIVE
To estimate the costs and benefits for a UK hospital pharmacy of stocking a single low molecular weight heparin (LMWH), enoxaparin, compared to stocking unfractionated heparin (UFH) and stocking both UFH and multiple different LMWHs.


METHODS
A decision-tree model was developed which considered the use of heparins for five indications: prophylaxis against venous thromboembolism (VTE) in major orthopaedic surgery; VTE prophylaxis in major general surgery; VTE prophylaxis in acute medical inpatients; treatment of diagnosed VTE; and anticoagulation for patients with unstable angina and non-ST-elevation myocardial infarction (UA/NSTEMI). Previously published cost-effectiveness analyses for each indication were combined into a single model and updated to 2002 prices. The number of patients given heparin in each indication was estimated from the pharmacy records of a large UK teaching hospital. The model estimated the use of drugs, staff time, clinical events and resource use resulting from anti-coagulation. Costs were estimated from the perspective of the hospital and the UK National Health Service.


RESULTS
Total annual cost was estimated to be pounds sterling 3.2 m (single LMWH), pounds sterling 4.4 m (UFH only) and pounds sterling 3.7 m (multiple heparins). The largest expected cost savings from using a single LMWH compared to UFH only resulted from reduced hospital stay for DVT treatment, reduced revascularisation in UA/NSTEMI and fewer VTE events in orthopaedic surgery. Expected cost savings from using a single LMWH compared to multiple heparins were more modest


CONCLUSIONS
Sub-optimal choice of anticoagulants may result in substantial excess costs elsewhere in the hospital.
Reeves
Penny
P
Fourth Hurdle Consulting Ltd, 2 Fisher Street, Holborn, London WC1R 4QA, UK. PennyReeves@FourthHurdle.com
Cooke
Jonathan
J
Lloyd
Adam
A
Hutchings
Adam
A
D000925:Anticoagulants / Q000191:economics* / Q000627:therapeutic use; D003365:Costs and Cost Analysis; D003663:Decision Trees; D016527:Drug Costs; D017984:Enoxaparin / Q000191:economics*; D006493:Heparin / Q000191:economics* / Q000627:therapeutic use; D006495:Heparin, Low-Molecular-Weight / Q000191:economics* / Q000627:therapeutic use; D006801:Humans; D007431:Intraoperative Complications / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control; D007445:Inventories, Hospital; D007902:Length of Stay; D018803:Models, Economic; D019637:Orthopedic Procedures / Q000009:adverse effects; D010607:Pharmacy Service, Hospital / Q000191:economics*; D013222:State Medicine; D013923:Thromboembolism / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control; D006113:United Kingdom
D000925:Anticoagulants; D017984:Enoxaparin; D006495:Heparin, Low-Molecular-Weight; D006493:Heparin