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Cost effectiveness of bemiparin sodium versus unfractionated heparin and oral anticoagulants in the acute and long-term treatment of deep vein thrombosis

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Abstract

Introduction: Low-molecular-weight heparins (LMWHs) are at least as effective and well tolerated as unfractionated heparin (UFH) in the treatment of deep vein thrombosis (DVT), offering easier administration and obviating the need for anticoagulant monitoring, but have a higher acquisition cost than UFH.

Objective: To quantify the potential economic impact of two regimens of subcutaneous bemiparin 115 IU/kg/day for 7–10 days (plus oral anticoagulants [OAC] or followed by long-term bemiparin 3500IU) versus dose-adjusted intravenous UFH for 7 days plus OAC for 3 months in the acute and long-term treatment of DVT. The representative patient was a 62-year-old, 77kg male with proximal DVT of the lower limbs.

Methods: A cost-effectiveness analysis was performed using a decision-tree modelling approach. The results were expressed in terms of costs (€, 2002 values) and incremental cost effectiveness. The treatment costs (hospital stay, physician services, drug administration) and costs incurred due to complications (pulmonary embolism, recurrent DVT, bleeding events, thrombocytopenia and deaths) during the 3-month study period were considered for the primary analysis. Life expectancy and QALYs were considered for the secondary analysis. The study was performed in the setting of the Spanish National Health System.

Results: Bemiparin plus OAC or long-term bemiparin for 3 months provided net cost savings of €769 and €908 per patient, respectively, compared with UFH plus OAC (UFH plus OAC €4128 vs bemiparin plus OAC €3359 vs long-term bemiparin €3220). Bemiparin plus OAC and long-term bemiparin for 3 months were calculated to avoid 27 and 7 additional VTE events, respectively, per 1000 patients treated. Bemiparin plus OAC or long-term bemiparin increased quality- -adjusted life expectancy by approximately 1.72 and 0.74 years, respectively, compared with UFH plus OAC. The univariate sensitivity analysis supported the cost effectiveness of bemiparin in all the ranges tested for complications and costs.

Conclusions: Our model suggests that bemiparin plus OAC or long-term bemiparin for 3 months may be dominant strategies over UFH plus OAC in the treatment of DVT from the Spanish National Health System perspective, offering better outcomes and cost savings. Long-term bemiparin may be a cost-neutral alternative to bemiparin plus OAC.

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Notes

  1. The use of trade names is for product identification purposes only and does not imply endorsement.

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Acknowledgements

The authors thank Alberto García Hernández and Jorge del Campo (Logitest, S.L.) for their assistance in providing statistical support during data analysis and manuscript preparation.

This study was financed by an unrestricted research grant from Laboratorios Farmacéuticos Rovi.

Antonio Gómez-Outes and Javier Martínez-González are employees of Rovi. There are no other relevant conflicts of interest.

All authors were responsible for the concept and design of the study and the interpretation of results. Antonio Gómez-Outes produced the first draft of the paper, and all authors were responsible for critical revision of the manuscript.

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Authors and Affiliations

  1. Medical Department, Laboratorios Farmacéuticos Rovi, S.A., Julián Camarillo 35, Madrid, 28037, Spain

    Antonio Gómez-Outes & Javier Martínez-González

  2. University Clinic of Navarra, Pamplona, Spain

    Eduardo Rocha

  3. Thrombosis Research Institute, London, UK

    Vijay V. Kakkar

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  1. Antonio Gómez-Outes
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Correspondence to Antonio Gómez-Outes.

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Gómez-Outes, A., Rocha, E., Martínez-González, J. et al. Cost effectiveness of bemiparin sodium versus unfractionated heparin and oral anticoagulants in the acute and long-term treatment of deep vein thrombosis. Pharmacoeconomics 24, 81–92 (2006). https://doi.org/10.2165/00019053-200624010-00007

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