Journal of General Internal Medicine

, Volume 15, Issue 2, pp 108–115

Cost-effectiveness of low-molecular-weight heparin in the treatment of proximal deep vein thrombosis

  • Carlos A. Estrada
  • Christopher J. Mansfield
  • Gustavo R. Heudebert
Original Articles

DOI: 10.1046/j.1525-1497.2000.03349.x

Cite this article as:
Estrada, C.A., Mansfield, C.J. & Heudebert, G.R. J GEN INTERN MED (2000) 15: 108. doi:10.1046/j.1525-1497.2000.03349.x

Abstract

OBJECTIVE: To estimate the cost-effectiveness of low-molecular-weight heparin (LMWH) in the treatment of proximal lower extremity deep venous thrombosis.

DESIGN: Cost-effectiveness analysis that includes the treatment of the index case and simulated 3-month follow-up.

SETTING: Acute care facility.

PATIENTS AND PARTICIPANTS: Hypothetical cohorts of 1,000 patients who present with proximal deep venous thrombosis.

INTERVENTIONS: Intravenous unfractionated heparin (UH), LMWH (40% at home, 60% in hospital), or selective UH/LMWH (UH for hospitalized patients and LMWH for patients treated at home).

MEASUREMENTS AND MAIN RESULTS: The outcomes were recurrent thrombosis, mortality, direct medical costs, and marginal cost-effectiveness ratios from the payer’s perspective. At the base-case and under most assumptions in the sensitivity analysis, the LMWH and the selective UH/LMWH strategies dominate the UH strategy i.e., they result in fewer cases of recurrent thrombosis and fewer deaths, and they save resources. The savings occur primarily by decreasing the length of stay. The LMWH strategy resulted in lower costs as compared with the UH strategy when the proportion of patients treated at home was more than 14%. Treating 1,000 patients with the LMWH strategy as compared with the UH/LMWH strategy would result in 10 fewer cases of recurrent thrombosis, 1.2 fewer deaths, at an additional cost of $96,822; the cost-effectiveness ratio was $9,667 and $80,685 per recurrent thrombosis or death prevented, respectively.

CONCLUSIONS: Treatment with LMWH leads to savings and better outcomes as compared with UH in patients with lower extremity deep venous thrombosis. The selective UH/LMWH strategy is an alternative option.

Key words

thromboembolismthrombophlebitisheparin, low molecular weightheparincost-benefit analysis

Copyright information

© Society of General Internal Medicine 2000

Authors and Affiliations

  • Carlos A. Estrada
    • 1
  • Christopher J. Mansfield
    • 1
  • Gustavo R. Heudebert
    • 2
  1. 1.East Carolina University School of Medicine, General Internal MedicineGreenville
  2. 2.University of Alabama at Birmingham and Birmingham Veterans Administration Medical CenterBirmingham