title: Low-molecular-weight heparins: pharmacoeconomic decision modeling based on meta-analysis data.
abstract: OBJECTIVE
  The aim of this study was to compare efficacy, safety, and consumption of low-molecular-weight heparins with unfractionated heparin, and to develop a pharmacoeconomic decision model based on meta-analysis data.
  
  
  METHODS
  Review and meta-analysis were performed of published randomized control trials directly comparing the safety and efficacy of low-molecular-weight heparins (LMWHs)-that is, nadroparin, enoxaparin, and dalteparin-and unfractionated heparin (UFH) was performed by two reviewers using inclusion/exclusion criteria based on the research objectives. The value of fixed effects and random effects odds ratio (95 percent confidence interval) was calculated for each trial for the composite end point. Subsequently, a pharmacoeconomic decision modeling based on reference pricing methodology was implemented.
  
  
  RESULTS
  In comparison to UFH, all LMWHs have independently demonstrated greater safety and effectiveness. None of the LMWHs demonstrated a significant superiority over each other; therefore, the group of LMWHs was interchangeable and suitable for cost minimization analysis and reference price implementation. Being the least expensive option, dalteparin single DDD price was set as the reference. Introduction of reference pricing for LMWHs would decrease the total expenditure on LMWHs of approximately 30 percent and would result in total savings of 1.830-2.070 thousand LTL in the country of Lithuania (approximately 0.8 million USD) per year.
  
  
  CONCLUSIONS
  The meta-analysis results of LMWHs could be used to support a policy on reference-based pricing and pharmacoeconomic decision modeling in healthcare institutions, which would allow a decrease in healthcare expenditures.
authors.affiliation: Kaunas Medical University and Kaunas Medical University Hospital. e610614@yahoo.com
authors.forename: Edmundas
authors.initials: E
authors.lastname: Kadusevicius
authors.forename: Gabriele
authors.initials: G
authors.lastname: Kildonaviciute
authors.forename: Birute
authors.initials: B
authors.lastname: Varanaviciene
authors.forename: Danguole
authors.initials: D
authors.lastname: Jankauskiene
mesh_terms: D003661:Decision Support Techniques; D017850:Economics, Pharmaceutical; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D006801:Humans
chemical_list: D006495:Heparin, Low-Molecular-Weight