title: Cost utility of substituting enoxaparin for unfractionated heparin for prophylaxis of venous thrombosis in the hospitalized medical patient.
abstract: BACKGROUND
  Both heparin and enoxaparin are effective for the prevention of venous thromboembolism (VTE) in medical patients. On the basis of price, heparin appears preferable because it is less expensive. However, choosing enoxaparin may have greater cost utility when the outcomes of heparin-induced thrombocytopenia (HIT) and heparin-induced thrombocytopenia with thrombosis (HITT) are considered.
  
  
  OBJECTIVE
  To determine the cost utility of substituting enoxaparin for heparin from payer and institutional perspectives.
  
  
  METHODS
  A decision analysis model was used. Cost data were based on Medicare reimbursement and the medication and laboratory costs for a multi-institutional healthcare system. Quality-adjusted life years (QALYs) saved by preventing HIT/HITT through the use of enoxaparin were based on published data. Costs are expressed on a per-day basis, and the incremental cost of enoxaparin over that of heparin was used in the calculation of cost/QALY. A sensitivity analysis also was performed.
  
  
  METHODS
  Inpatient medicine.
  
  
  METHODS
  All medical patients for whom VTE prophylaxis was appropriate.
  
  
  METHODS
  Substitution of enoxaparin for heparin.
  
  
  METHODS
  Cost/QALY.
  
  
  RESULTS
  From a payer perspective, using enoxaparin resulted in a decrease in cost of 28.61 dollars over that of heparin and saved 0.00629 QALYs in the base case, resulting in a savings of 4550.17 dollars/QALY. The sensitivity analysis showed this finding of decreased cost and increased effectiveness to be consistent. From an institutional perspective, the use of heparin generally appeared less costly but was dependent on medication price, length of stay required, and bed utilization.
  
  
  CONCLUSIONS
  From a payer and, by extrapolation, a societal perspective, cost-utility analysis supports the use of enoxaparin in place of heparin for the prevention of VTE in medical inpatients. From an institutional perspective, the decision is more complicated, but in most cases, the use of enoxaparin also is supported.
authors.affiliation: South Texas Veterans Health Care System, San Antonio, Texas, USA. leykum@uthscsa.edu
authors.forename: Luci
authors.initials: L
authors.lastname: Leykum
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Pugh
authors.forename: David
authors.initials: D
authors.lastname: Diuguid
authors.forename: Kyriakos
authors.initials: K
authors.lastname: Papadopoulos
mesh_terms: D003365:Costs and Cost Analysis / Q000379:methods; D017984:Enoxaparin / Q000191:economics* / Q000627:therapeutic use; D006493:Heparin / Q000191:economics* / Q000627:therapeutic use; D017721:Hospital Costs; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D006278:Medicare / Q000191:economics; D020246:Venous Thrombosis / Q000188:drug therapy / Q000191:economics*
chemical_list: D017984:Enoxaparin; D006493:Heparin