M. Rodger et al., COST-EFFECTIVENESS OF LOW-MOLECULAR-WEIGHT HEPARIN AND UNFRACTIONATEDHEPARIN IN TREATMENT OF DEEP-VEIN THROMBOSIS, CMAJ. Canadian Medical Association journal, 159(8), 1998, pp. 931-938
Background: Acute deep vein thrombosis has traditionally been treated
with unfractionated heparin (UFH), administered intravenously, but low
-molecular-weight heparins (LMWH), administered subcutaneously, have r
ecently become available. The authors sought to determine which therap
y was more cost-effective for inpatient and outpatient treatment of de
ep vein thrombosis. Methods: An incremental cost-effectiveness analysi
s based on a decision tree was performed for 4 treatment strategies fo
r deep vein thrombosis. Rate of major hemorrhage while receiving hepar
in, rate of recurrence of venous thromboembolism 3 months after treatm
ent and mortality rate 3 months after treatment were determined by met
a-analysis. Costs for the UFH therapy were prospectively collected by
a case-costing accounting system for 105 patients with deep vein throm
bosis treated in fiscal year 1995/96. The costs for LMWH therapy were
modelled, and cost-effectiveness was determined by decision analysis.
Results: Meta-analysis revealed a mean difference in risk of hemorrhag
e of -1.1% (95% confidence interval [Cl] -2.4% to 0.3%), a mean differ
ence in risk of recurrence of venous thromboembolism of -2.6% (95% Cl
-4.5% to -0.7%) and a mean difference in risk of death of -1.9% (95% C
l -3.6% to -0.4%), all in favour of subcutaneous unmonitored administr
ation of LMWH. The cost to treat one inpatient was $2993 for LMWH and
$3048 for UFH. Even more would be saved if LMWH was delivered on an ou
tpatient basis (cost of $1641 per patient). The cost-effectiveness ana
lysis showed that LMWH in any treatment setting is more cost effective
than UFH. A sensitivity analysis demonstrated the robustness of this
conclusion. Interpretation: Treatment of deep vein thrombosis with LMW
H is more cost effective than treatment with UFH in both inpatient and
outpatient settings.