Cost for inpatient care of venous thrombosis - A trial of enoxaparin vs standard heparin

Background: Enoxaparin, a few-molecular-weight heparin administered to hosp italized. patients once or twice daily, has shown efficacy and safety equiv alent to unfractionated heparin in the treatment of acute venous thromboemb olic disease. Although the cost of either enoxaparin regimen is greater tha n chat of unfractionated heparin, the overall cost of care for each of thes e 3 treatment strategies is unknown. Methods: A cost minimization analysis of a 3-month, partially blinded, rand omized, controlled efficacy and safety trial of anticoagulant therapy for d eep vein thrombosis. Three hundred thirty-nine hospitalized patients with s ymptomatic lower extremity deep vein thrombosis were randomly assigned to i nitial therapy with-subcutaneous enoxaparin either once (n=112) pr twice (n =123) daily, or with dose-adjusted intravenous unfractionated heparin (n=10 4), followed by long-term oral anticoagulant therapy. Estimated 1997 total cost from a third-party payer perspective for the 3-month episode of care w as calculated by assigning standard unit costs to counts of medical resourc es used by each patient in the clinical trial. Results: Average total cost for the 3-month episode of care was similar acr oss all 3 treatment regimens: once-daily dose of enoxaparin, $12166 (95% co nfidence interval [ CI], $10744-$13588); twice-daily dose of enoxaparin, $1 1558 (95% CI, $10201-$12915); and unfractionated heparin, $12146 (95% CI, $ 10670-$12622). Bootstrapped estimates and sensitivity analyses did not sign ificantly change findings. Conclusions: There was no significant difference in the overall cost for th e 3-month episode of care for patients treated with either enoxaparin or un fractionated heparin. Additional acquisition costs for anticoagulant medica tion among patients treated with enoxaparin were offset by savings associat ed with lower incidence of hospital readmission and shorter duration of ven ous thromboembolism-related readmissions.