PMID- 16153135
OWN - NLM
STAT- MEDLINE
DCOM- 20051129
LR  - 20181113
IS  - 1170-7690 (Print)
IS  - 1170-7690 (Linking)
VI  - 23
IP  - 9
DP  - 2005
TI  - Cost effectiveness of dalteparin for preventing venous thromboembolism in 
      abdominal surgery.
PG  - 927-44
AB  - INTRODUCTION: Patients undergoing abdominal surgeries face substantial risk of 
      experiencing venous thromboembolic events in the perioperative period. The 
      low-molecular-weight heparin dalteparin sodium is clinically effective in 
      reducing the incidence of venous thromboembolism (VTE) in these patients. 
      Dalteparin may be used in low (2500 units [U]) and high (5000 U) once-daily doses 
      for this indication. However, the cost effectiveness of dalteparin 5000 U 
      compared with dalteparin 2500 U and unfractionated heparin (UFH) for this 
      indication has not been studied. OBJECTIVE: To conduct a cost-utility analysis to 
      evaluate the cost effectiveness of dalteparin compared with UFH for preventing 
      VTE in patients undergoing elective abdominal surgery. METHODS: A Markov model, 
      from a healthcare perspective, was constructed to evaluate the cost effectiveness 
      of dalteparin 5000 U and dalteparin 2500 U compared with UFH. A 69-year-old mixed 
      sex patient population was studied using pooled probabilities of clinical 
      outcomes from randomised, controlled trials. Cost data were mostly derived from 
      Medicare reimbursement, in year 2002-03 values. Cost effectiveness was measured 
      as cost per QALY gained over the patient's lifetime. RESULTS: Total costs for 
      patients given UFH, dalteparin 2500 U and dalteparin 5000 U were US45,855 
      dollars, US45,882 dollars and US46,308 dollars, respectively, while QALYs were 
      9.5603, 9.5632 and 9.5811, respectively. Hence, the incremental cost 
      effectiveness of dalteparin 5000 U over dalteparin 2500 U and UFH was US23,799 
      dollars/QALY and US21,779 dollars/QALY gained, respectively. Similarly, cost 
      effectiveness for dalteparin 2500 U over UFH was US9310 dollars/QALY gained. 
      Univariate sensitivity analysis showed that dalteparin 5000 U maintained its cost 
      effectiveness (incremental cost-effectiveness ratio [ICER] <US50 000 dollars/QALY 
      gained) over the other two regimens for a wide range of cost and effectiveness 
      estimates. Acceptability curves based on the results of Monte Carlo simulation 
      (50,000 patients) showed that dalteparin 5000 U would achieve cost effectiveness 
      for 90% of patients at values close to US230,000 dollars/QALY. Dalteparin 2500 U 
      was less effective than UFH for patients aged <63 years. CONCLUSION: Even though 
      our base-case analysis seems to show that dalteparin 5000 U is cost effective 
      compared with dalteparin 2500 U and UFH for prophylaxis of VTE in patients 
      undergoing abdominal surgery, Monte Carlo simulation demonstrated that this was 
      the case for only about 50% of the patients if the threshold for cost 
      effectiveness is set at US50,000 dollars per QALY gained. Furthermore, there was 
      substantial uncertainty in the cost-effectiveness results. To ensure that > or 
      =90% patients receive the benefit of the medication, policy makers would need to 
      commit substantially more resources than suggested by the baseline ICERs.
FAU - Heerey, Adrienne
AU  - Heerey A
AD  - Department of Cardiovascular Health Economics, Cleveland Clinic Foundation, 
      Cleveland, Ohio 44195, USA.
FAU - Suri, Sanjeev
AU  - Suri S
LA  - eng
PT  - Journal Article
PL  - New Zealand
TA  - Pharmacoeconomics
JT  - PharmacoEconomics
JID - 9212404
RN  - 0 (Anticoagulants)
RN  - S79O08V79F (Dalteparin)
MH  - Abdomen/*surgery
MH  - Aged
MH  - Aged, 80 and over
MH  - Anticoagulants/*economics
MH  - *Cost-Benefit Analysis
MH  - Dalteparin/*economics/therapeutic use
MH  - Female
MH  - Humans
MH  - Male
MH  - Models, Economic
MH  - Thromboembolism/*prevention & control
MH  - Venous Thrombosis/*prevention & control
EDAT- 2005/09/13 09:00
MHDA- 2005/12/13 09:00
CRDT- 2005/09/13 09:00
PHST- 2005/09/13 09:00 [pubmed]
PHST- 2005/12/13 09:00 [medline]
PHST- 2005/09/13 09:00 [entrez]
AID - 2395 [pii]
AID - 10.2165/00019053-200523090-00005 [doi]
PST - ppublish
SO  - Pharmacoeconomics. 2005;23(9):927-44. doi: 10.2165/00019053-200523090-00005.