Cost and utility of a low-molecular-weight heparin and unfractionated heparin for treatment of deep venous thrombosis in a Balkan country: A model analysis.
OBJECTIVE
Low-molecular-weight heparins are cost-saving for treating venous thrombosis in developed countries, but their cost-effectiveness in developing Balkan countries has not been investigated. The objective of the present study was to evaluate whether the results of cost-effectiveness studies of low-molecular-weight heparins versus unfractionated heparin for treatment of acute deep venous thrombosis conducted in a developed country are applicable to Serbian socioeconomic circumstances.


METHODS
A Markov model was constructed based on the decision model used by Gould et al (Ann Intern Med 1999;130:789-99), with the help of TreeAge Software (TreeAge Software Inc, USA). Probabilities for clinical outcomes were obtained from that study, while the costs were derived from the Serbian Republic Institute for Health Insurance and other sources. Patients with acute deep venous thrombosis, 60 years of age, were introduced into the model. A Monte Carlo microsimulation trial with 1000 patients was used for drawing conclusions from the model. The time horizon was six years, and the Serbian Republic Institute for Health Insurance was used.


RESULTS
Enoxaparin for treatment of deep venous thrombosis in Serbian patients was not cost-saving, but was a cost-effective therapeutic strategy (from 5,322.97 CSD [Serbia and Montenegro dinars] per quality-adjusted life-year gained when used in out-patients, to 10,929.76 CSD per quality-adjusted life-year gained when used in inpatients). The drug acquisition cost was the major factor influencing the cost-effectiveness, due to the low cost of labour and hospitalization.


CONCLUSIONS
The results of pharmacoeconomic studies performed in developed countries cannot be directly extrapolated to developing Balkan countries. However, enoxaparin is still a cost-effective strategy for the treatment of deep venous thrombosis.
Jankovic
Slobodan M
SM
Pharmacology Department, Medical Faculty, University of Kragujevac, Kragujevac, Serbia and Montenegro.
Milovanovic
Dragan R
DR