Effectiveness and economic impact associated with a program for outpatientmanagement of acute deep vein thrombosis in a group model health maintenance organization

Background: Controlled clinical trials have demonstrated that outpatient ad ministration of low-molecular-weight heparin to patients with acute deep ve in thrombosis (DVT) provides safety and efficacy equivalent to that of trad itional inpatient therapy with unfractionated heparin. Whether favorable re sults reported in controlled clinical trials are achievable in clinical pra ctice is an important consideration. Methods: Appropriate patients with objectively diagnosed DVT were treated a s outpatients with low molecular-weight heparin and warfarin sodium accordi ng to an approved guideline. The primary end point for analysis consisted o f objectively diagnosed symptomatic recurrent thromboembolism or major blee ding within a 90-day evaluation period. The incremental cost incurred by th e organization while using the outpatient DVT treatment guideline was deter mined, Incremental cost savings of the outpatient DVT treatment program wer e determined based on the cost that would have accrued had the patient been admitted to the hospital for treatment with unfractionated heparin, Results: We enrolled 391 patients (91.4%) in the outpatient DVT treatment p rogram. Of these, 373 (95.4%) completed 90 days of therapy without reaching the primary end point. The percentage of patients reaching the primary out come measure (4.6%) fell within the range of patients enrolled in controlle d clinical trials (3.5%-9.4%). During the 2-year program evaluation, total cost savings of $1 108 587 were realized. Conclusions: Outpatient treatment of acute DVT can be managed safely and ef fectively in clinical practice. The potential savings associated with outpa tient DVT treatment are substantial.