Subcutaneous low-molecular-weight heparin is at least as effective and safe as classic intravenous heparin therapy for the treatment of proximal vein thrombosis. Anticoagulant monitoring is not required with low-molecular-weight heparin.
To perform an economic evaluation of these therapeutic approaches by comparing cost and effectiveness.
Patients and Methods:
A randomized trial in 432 patients with proximal vein thrombosis that compared intravenous heparin and low-molecular-weight heparin with objective documentation of clinical outcomes provided the opportunity to perform an analysis of cost-effectiveness to rank these alternative therapies in terms of both their cost and effectiveness. The economic viewpoint of this analysis was that of a third-party payer (ie, a ministry of health in Canada or an insurance company in the United States).
In the intravenous heparin-treated group, the cost incurred for 100 patients was $414 655 (Canadian dollars) or $375 836 (US dollars), with a frequency of objectively documented venous thromboembolism of 6.9%. In the low-molecular-weight heparin—treated group, the cost incurred for 100 patients was $399 403 (Canadian dollars) or $335 687 (US dollars), with a frequency of objectively documented venous thromboembolism of 2.8%, thus providing a cost saving of $15 252 (Canadian dollars) or $40 149 (US dollars). Multiple sensitivity analyses were performed, and these procedures did not alter the findings of the study.Conclusions:The findings indicate that low-molecular-weight heparin therapy is at least as effective and safe but less costly than intravenous heparin treatment. The potential for outpatient therapy in up to 37% of patients who are receiving low-molecular-weight heparin would substantially augment the cost saving.Arch Intern Med. 1997;157:289-294
Hull RD, Raskob GE, Rosenbloom D, Pineo GF, Lerner RG, Gafni A, Trowbridge AA, Elliott CG, Green D, Feinglass J, Feldstein W, Brant R. Treatment of Proximal Vein Thrombosis With Subcutaneous Low-Molecular-Weight Heparin vs Intravenous HeparinAn Economic Perspective. Arch Intern Med. 1997;157(3):289–294. doi:10.1001/archinte.1997.00440240051008