TREATMENT OF PROXIMAL VEIN-THROMBOSIS WITH SUBCUTANEOUS LOW-MOLECULAR-WEIGHT HEPARIN VS INTRAVENOUS HEPARIN - AN ECONOMIC-PERSPECTIVE

Background: Subcutaneous low-molecular-weight heparin is at least as e ffective and safe as classic intravenous heparin therapy for the treat ment of proximal vein thrombosis. Anticoagulant monitoring is not requ ired with low-molecular-weight heparin. Objective: To perform an econo mic evaluation of these therapeutic approaches by comparing cost and e ffectiveness. Patients and Methods: A randomized trial in 432 patients with proximal vein thrombosis that compared intravenous heparin and l ow-molecular-weight heparin with objective documentation of clinical o utcomes provided the opportunity to perform an analysis of cost-effect iveness to rank these alternative therapies in terms of both their cos t and effectiveness. The economic viewpoint of this analysis was that of a third-party payer (ie, a ministry of health in Canada or an insur ance company in the United States). Results: In the intravenous hepari n-treated group, the cost incurred for 100 patients was $414 655 (Cana dian dollars) or $375 836 (US dollars), with a frequency of objectivel y documented venous thromboembolism of 6.9%. Tn the low-molecular-weig ht heparin-treated group, the cost incurred for 100 patients was $399 403 (Canadian dollars) or $335 687 (US dollars), with a frequency of o bjectively documented venous thromboembolism of 2.8%, thus providing a cost saving of $15 252 (Canadian dollars) or $40 149 (US dollars). Mu ltiple sensitivity analyses were performed, and these procedures did n ot alter the findings of the study. Conclusions: The findings indicate that low-molecular-weight heparin therapy is at least as effective an d safe but less costly than intravenous heparin treatment. The potenti al for outpatient therapy in up to 37% of patients who are receiving l ow-molecular-weight heparin would substantially augment the cost savin g.