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Low-molecular-weight heparins compared with unfractionated heparin for treatment of acute deep venous thrombosis. A cost-effectiveness analysis.

Publication ,  Journal Article
Gould, MK; Dembitzer, AD; Sanders, GD; Garber, AM
Published in: Ann Intern Med
May 18, 1999

BACKGROUND: Low-molecular-weight heparins are effective for treating venous thrombosis, but their cost-effectiveness has not been rigorously assessed. OBJECTIVE: To evaluate the cost-effectiveness of low-molecular-weight heparins compared with unfractionated heparin for treatment of acute deep venous thrombosis. DESIGN: Decision model. DATA SOURCES: Probabilities for clinical outcomes were obtained from a meta-analysis of randomized trials. Cost estimates were derived from Medicare reimbursement and other sources. TARGET POPULATION: Two hypothetical cohorts of 60-year-old men with acute deep venous thrombosis. TIME HORIZON: Patient lifetime. PERSPECTIVE: Societal. INTERVENTION: Fixed-dose low-molecular-weight heparin or adjusted-dose unfractionated heparin. OUTCOME MEASURES: Costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios. An in-patient hospital setting was used for the base-case analysis. Secondary analyses examined outpatient treatment with low-molecular-weight heparin. RESULTS OF BASE-CASE ANALYSIS: Total costs for inpatient treatment were $26,516 for low-molecular-weight heparin and $26,361 for unfractionated heparin. The cost of initial care was higher in patients who received low-molecular-weight heparin, but this was partly offset by reduced costs for early complications. Low-molecular-weight heparin treatment increased quality-adjusted life expectancy by approximately 0.02 years. The incremental cost-effectiveness of inpatient low-molecular-weight heparin treatment was $7820 per QALY gained. Treatment with low-molecular-weight heparin was cost saving when as few as 8% of patients were treated at home. RESULTS OF SENSITIVITY ANALYSIS: When late complications were assumed to occur 25% less frequently in patients who received unfractionated heparin, the incremental cost-effectiveness ratio increased to almost $75,000 per QALY gained. When late complications were assumed to occur 25% less frequently in patients who received low-molecular-weight heparin, this treatment resulted in a net cost savings. Inpatient low-molecular-weight heparin treatment became cost saving when its pharmacy cost was reduced by 31% or more, when it reduced the yearly incidence of late complications by at least 7%, when as few as 8% of patients were treated entirely as outpatients, or when at least 13% of patients were eligible for early discharge. CONCLUSIONS: Low-molecular-weight heparins are highly cost-effective for inpatient management of venous thrombosis. This treatment reduces costs when small numbers of patients are eligible for outpatient management.

Duke Scholars

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Published In

Ann Intern Med

DOI

ISSN

0003-4819

Publication Date

May 18, 1999

Volume

130

Issue

10

Start / End Page

789 / 799

Location

United States

Related Subject Headings

  • Venous Thrombosis
  • Sensitivity and Specificity
  • Recurrence
  • Randomized Controlled Trials as Topic
  • Quality-Adjusted Life Years
  • Pulmonary Embolism
  • Multivariate Analysis
  • Middle Aged
  • Male
  • Life Expectancy
 

Citation

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Gould, M. K., Dembitzer, A. D., Sanders, G. D., & Garber, A. M. (1999). Low-molecular-weight heparins compared with unfractionated heparin for treatment of acute deep venous thrombosis. A cost-effectiveness analysis. Ann Intern Med, 130(10), 789–799. https://doi.org/10.7326/0003-4819-130-10-199905180-00002
Gould, M. K., A. D. Dembitzer, G. D. Sanders, and A. M. Garber. “Low-molecular-weight heparins compared with unfractionated heparin for treatment of acute deep venous thrombosis. A cost-effectiveness analysis.Ann Intern Med 130, no. 10 (May 18, 1999): 789–99. https://doi.org/10.7326/0003-4819-130-10-199905180-00002.
Gould, M. K., et al. “Low-molecular-weight heparins compared with unfractionated heparin for treatment of acute deep venous thrombosis. A cost-effectiveness analysis.Ann Intern Med, vol. 130, no. 10, May 1999, pp. 789–99. Pubmed, doi:10.7326/0003-4819-130-10-199905180-00002.

Published In

Ann Intern Med

DOI

ISSN

0003-4819

Publication Date

May 18, 1999

Volume

130

Issue

10

Start / End Page

789 / 799

Location

United States

Related Subject Headings

  • Venous Thrombosis
  • Sensitivity and Specificity
  • Recurrence
  • Randomized Controlled Trials as Topic
  • Quality-Adjusted Life Years
  • Pulmonary Embolism
  • Multivariate Analysis
  • Middle Aged
  • Male
  • Life Expectancy