title: Cost-effectiveness of low-molecular-weight heparin for secondary prophylaxis of cancer-related venous thromboembolism.
abstract: Although extended secondary prophylaxis with low-molecular-weight heparin was recently shown to be more effective than warfarin for cancer-related venous thromboembolism, its cost-effectiveness compared to traditional prophylaxis with warfarin is uncertain. We built a decision analytic model to evaluate the clinical and economic outcomes of a 6-month course of low-molecular-weight heparin or warfarin therapy in 65-year-old patients with cancer-related venous thromboembolism. We used probability estimates and utilities reported in the literature and published cost data. Using a US societal perspective, we compared strategies based on quality-adjusted life-years (QALYs) and lifetime costs. The incremental cost-effectiveness ratio of low-molecular-weight heparin compared with warfarin was 149,865 dollars/QALY. Low-molecular-weight heparin yielded a quality-adjusted life expectancy of 1.097 QALYs at the cost of 15,329 dollars. Overall, 46% (7108 dollars) of the total costs associated with low-molecular-weight heparin were attributable to pharmacy costs. Although the low-molecular-weigh heparin strategy achieved a higher incremental quality-adjusted life expectancy than the warfarin strategy (difference of 0.051 QALYs), this clinical benefit was offset by a substantial cost increment of 7,609 dollars. Cost-effectiveness results were sensitive to variation of the early mortality risks associated with low-molecular-weight heparin and warfarin and the pharmacy costs for low-molecular-weight heparin. Based on the best available evidence, secondary prophylaxis with low-molecular-weight heparin is more effective than warfarin for cancer-related venous thromboembolism. However, because of the substantial pharmacy costs of extended low-molecular-weight heparin prophylaxis in the US, this treatment is relatively expensive compared with warfarin.
authors.affiliation: Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pennsylvania, USA. aujesky@swissonline.ch
authors.forename: Drahomir
authors.initials: D
authors.lastname: Aujesky
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Smith
authors.forename: Jacques
authors.initials: J
authors.lastname: Cornuz
authors.forename: Mark S
authors.initials: MS
authors.lastname: Roberts
mesh_terms: D003362:Cost-Benefit Analysis; D003658:Decision Making, Computer-Assisted; D006495:Heparin, Low-Molecular-Weight / Q000191:economics* / Q000627:therapeutic use; D006801:Humans; D009369:Neoplasms / Q000150:complications*; D011292:Premedication / Q000191:economics* / Q000379:methods; D019057:Quality-Adjusted Life Years; D013923:Thromboembolism / Q000188:drug therapy / Q000191:economics; D014481:United States; D020246:Venous Thrombosis / Q000188:drug therapy* / Q000191:economics; D014859:Warfarin / Q000191:economics / Q000627:therapeutic use
chemical_list: D006495:Heparin, Low-Molecular-Weight; D014859:Warfarin