PMID- 17473570
OWN - NLM
STAT- MEDLINE
DCOM- 20070703
LR  - 20191210
IS  - 0957-5235 (Print)
IS  - 0957-5235 (Linking)
VI  - 18
IP  - 4
DP  - 2007 Jun
TI  - Low-molecular weight heparin for deep vein thrombosis prophylaxis in hospitalized 
      medical patients: results from a cost-effectiveness analysis.
PG  - 309-16
AB  - Multiple options exist for the prevention of deep vein thrombosis (DVT) in 
      medical inpatients. We sought to determine the cost-effectiveness of 
      low-molecular-weight heparin (LMWH) relative to unfractionated heparin (UFH) for 
      DVT prevention in this setting. We conducted a cost-effectiveness analysis from 
      the perspective of a third-party payer employing a decision model and 
      literature-based estimates for inputs. In the base-case analysis, LMWH had little 
      impact on the rate of DVT. Despite higher acquisition costs, however, LMWHs 
      resulted in net savings. Routine use of LMWH saves approximately US$89 per 
      patient. The lower rate of heparin-induced thrombocytopenia (HIT) with LMWH 
      accounted for this differential. Univariate sensitivity analysis revealed the 
      model was moderately sensitive to the odds ratio of HIT with LMWH and the cost of 
      HIT. Multivariate sensitivity analysis confirmed the LMWH approach dominated 
      financially. 'Worst-case' scenario modeling, where LMWH actually increased the 
      risk for DVT, had little effect on the rate of HIT, and was substantially more 
      costly than UFH, still demonstrated that LMWHs were economically superior. 
      Monte-Carlo simulation indicated the 95% confidence interval around the estimate 
      for savings with LMWH ranged from US$7 to US$373. We conclude that, despite their 
      higher cost, LMWHs for thromboprophylaxis in medical patients result in savings.
FAU - Shorr, Andrew F
AU  - Shorr AF
AD  - Pulmonary & Critical Care Medicine Service, Washington Hospital Center, 110 
      Irving Street NW, Washington, DC 20010, USA. afshorr@dnamail.com
FAU - Jackson, William L
AU  - Jackson WL
FAU - Weiss, Brendan M
AU  - Weiss BM
FAU - Moores, Lisa K
AU  - Moores LK
LA  - eng
PT  - Evaluation Study
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - England
TA  - Blood Coagul Fibrinolysis
JT  - Blood coagulation & fibrinolysis : an international journal in haemostasis and 
      thrombosis
JID - 9102551
RN  - 0 (Anticoagulants)
RN  - 0 (Heparin, Low-Molecular-Weight)
SB  - IM
MH  - Anticoagulants/*economics/*therapeutic use
MH  - Cost-Benefit Analysis
MH  - Heparin, Low-Molecular-Weight/*economics/*therapeutic use
MH  - Humans
MH  - *Inpatients
MH  - Monte Carlo Method
MH  - Multivariate Analysis
MH  - Venous Thrombosis/economics/*prevention & control
EDAT- 2007/05/03 09:00
MHDA- 2007/07/04 09:00
CRDT- 2007/05/03 09:00
PHST- 2007/05/03 09:00 [pubmed]
PHST- 2007/07/04 09:00 [medline]
PHST- 2007/05/03 09:00 [entrez]
AID - 00001721-200706000-00003 [pii]
AID - 10.1097/MBC.0b013e328099af58 [doi]
PST - ppublish
SO  - Blood Coagul Fibrinolysis. 2007 Jun;18(4):309-16. doi: 
      10.1097/MBC.0b013e328099af58.