LOW-MOLECULAR-WEIGHT VERSUS UNFRACTIONATED HEPARIN - A CLINICAL AND ECONOMIC APPRAISAL

Unfractionated heparin (UFH) has been in clinical use for over 50 year s and extensive clinical trials have demonstrated its effectiveness in the prevention and treatment of thrombotic disease. In the last 2 dec ades, low molecular weight heparins (LMWHs) have been developed and su bjected to extensive laboratory and clinical studies. In clinical comp arison with UFH in the treatment of venous thromboembolism, LMWHs appe ar to offer a superior benefit-risk profile. In addition, the ease of drug administration and lack of drug monitoring associated with LMWHs are attractive clinical features. We calculated the overall costs of U FH and LMWH therapy using recently published clinical data and local c ost information. Although the acquisition costs of LMWHs are higher th an for UFH, LMWHs are more cost effective in surgical prophylaxis of d eep venous thrombosis (DVT) if the costs of failed prophylaxis are con sidered. The costs of using subcutaneous (SC) LMWH as therapy for esta blished DVT are lower than those of UFH administered by intravenous in fusion. The financial benefit of using LMWH treatment becomes more pro nounced when the rates of antithrombotic failure and bleeding complica tions are incorporated. If UFH is given by SC injection, however, the cost differential favouring LMWH for the treatment of DVT is not so gr eat. If current trials demonstrate that LMWH treatment can be given on an ambulatory outpatient basis, the economic advantages of LMWH will be considerable. However, the extent of this will vary from place to p lace depending on local funding arrangements.