title: Cost savings and effectiveness of outpatient treatment with low molecular weight heparin of deep vein thrombosis in a community hospital.
abstract: This study was conducted at Centenary Health Centre of the Rouge Valley Health System, a community based hospital in Toronto. In January 1997, a new treatment was introduced for the management of patients with uncomplicated deep vein thrombosis (DVT). Eligible patients presenting at the ER were placed on LMWH (tinzaparin) and followed at home. Previously the patients had been hospitalized and treated with intravenous heparin until they reached a therapeutic international normalized ratio (INR). The intent of this study was to evaluate the patient outcomes and cost-savings of the new approach.
  
  
  METHODS
  Data from all patients eligible for home care, treated in 1996 were assembled and compared with those from all eligible patients treated from April 1, 1997 to March 31, 1998. The data was collected by chart review and consisted of patient outcomes and costs during the period of heparin treatment. Costs for hospitalized patients were based on a per diem. For home care patients, the costs were itemized according to service and medication usage. All costs were calculated in 1999 Canadian dollars.
  
  
  RESULTS
  In each one year period, 39 cases were treated. There was no serious adversity and the outcomes were compatible with what has been reported in the literature. The mean cost per patient for the 1996 hospitalized cohort was $3,266 compared to $584 for the subsequent home care cohort. The difference was statistically significant (p<0.00001).
  
  
  CONCLUSIONS
  Home care with tinzaparin compared to hospital care with IV heparin resulted in a large mean saving per patient with no difference in outcome.
authors.affiliation: Pharmacy Services, Rouge Valley Health System, Toronto, Canada.
authors.forename: Ming
authors.initials: M
authors.lastname: Lee
authors.forename: David
authors.initials: D
authors.lastname: Pao
authors.forename: Tom
authors.initials: T
authors.lastname: Hsu
authors.forename: Anne
authors.initials: A
authors.lastname: Sonderskov
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000191:economics* / Q000706:statistics & numerical data; D017046:Cost Savings / Q000191:economics* / Q000706:statistics & numerical data; D003362:Cost-Benefit Analysis / Q000191:economics / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006495:Heparin, Low-Molecular-Weight / Q000191:economics* / Q000627:therapeutic use; D006764:Hospitals, Community / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D020246:Venous Thrombosis / Q000188:drug therapy / Q000191:economics*
chemical_list: D006495:Heparin, Low-Molecular-Weight