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18 May 1999 | Volume 130 Issue 10 | Pages 789-799
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 inpatient 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.
Author and Article Information
From Veterans Affairs Palo Alto Health Care System, Palo Alto, California; and Stanford University Medical Center and Stanford University, Stanford, California.
Grant Support: By grant HS00028-11 from the Agency for Health Care Policy and Research, Rockville, Maryland.
Request for Reprints: Michael K. Gould, MD, MSc, Pulmonary and Critical Care Section, 111P, Veterans Affairs Palo Alto Health Care System, 3801 Miranda Avenue, Palo Alto, CA 94304; e-mail, gould{at}stanford.edu.
Current Author Addresses: Dr. Gould: Pulmonary and Critical Care Section, 111P, Veterans Affairs Palo Alto Health Care System, 3801 Miranda Avenue, Palo Alto, CA 94304.
Dr. Dembitzer: Department of Medicine, Veterans Affairs Palo Alto Health Care System, 3801 Miranda Avenue, Palo Alto, CA 94304.
Dr. Sanders: Department of Medicine, HRP Redwood Building T242, Stanford University Medical Center, Stanford, CA 94305.
Dr. Garber: Center for Primary Care and Outcomes Research, Stanford University Medical Center, 30 Alta Road, Stanford, CA 94305. ARTICLE
Low-Molecular-Weight Heparins Compared with Unfractionated Heparin for Treatment of Acute Deep Venous Thrombosis: A Cost-Effectiveness Analysis
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