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An Economic Perspective

Russell D. Hull, MBBS, MSc; Gary E. Raskob, MSc; David Rosenbloom, PharmD; Graham F. Pineo, MD; Robert G. Lerner, MD; Amiram Gafni, PhD; Arthur A. Trowbridge, MD; C. Gregory Elliott, MD; David Green, MD, PhD; Joseph Feinglass, PhD; William Feldstein, MBA; Rollin Brant, PhD

Arch Intern Med. 1997;157(3):289-294.

Abstract
Background
Subcutaneous low-molecular-weight heparin is at least as effective and safe as classic intravenous heparin therapy for the treatment of proximal vein thrombosis. Anticoagulant monitoring is not required with low-molecular-weight heparin.

Objective
To perform an economic evaluation of these therapeutic approaches by comparing cost and effectiveness.

Patients and Methods
A randomized trial in 432 patients with proximal vein thrombosis that compared intravenous heparin and low-molecular-weight heparin with objective documentation of clinical outcomes provided the opportunity to perform an analysis of cost-effectiveness to rank these alternative therapies in terms of both their cost and effectiveness. The economic viewpoint of this analysis was that of a third-party payer (ie, a ministry of health in Canada or an insurance company in the United States).

Results
In the intravenous heparin-treated group, the cost incurred for 100 patients was $414 655 (Canadian dollars) or $375 836 (US dollars), with a frequency of objectively documented venous thromboembolism of 6.9%. In the low-molecular-weight heparin—treated group, the cost incurred for 100 patients was $399 403 (Canadian dollars) or $335 687 (US dollars), with a frequency of objectively documented venous thromboembolism of 2.8%, thus providing a cost saving of $15 252 (Canadian dollars) or $40 149 (US dollars). Multiple sensitivity analyses were performed, and these procedures did not alter the findings of the study.

Conclusions:

The findings indicate that low-molecular-weight heparin therapy is at least as effective and safe but less costly than intravenous heparin treatment. The potential for outpatient therapy in up to 37% of patients who are receiving low-molecular-weight heparin would substantially augment the cost saving.

Arch Intern Med. 1997;157:289-294

Author Affiliations
From the Clinical Trials Unit, The University of Calgary, Alberta (Drs Hull, Pineo, and Brant and Mr Feldstein); the Department of Biostatistics, Epidemiology, and Medicine, University of Oklahoma, Oklahoma City (Mr Raskob); the Departments of Medicine (Dr Rosenbloom) and Clinical Epidemiology and Biostatistics (Dr Gafni), McMaster University, Hamilton, Ontario; New York Medical College, Valhalla (Dr Lerner); the Scott & White Clinic, Temple, Tex (Dr Trowbridge); the LDS Hospital, Salt Lake City, Utah (Dr Elliott); and the Department of Medicine, Northwestern University Medical School, Chicago, Ill (Drs Green and Feinglass).

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