PMID- 18989525
OWN - NLM
STAT- MEDLINE
DCOM- 20081222
LR  - 20081107
IS  - 0340-6245 (Print)
IS  - 0340-6245 (Linking)
VI  - 100
IP  - 5
DP  - 2008 Nov
TI  - Comparison of the two-year outcomes and costs of prophylaxis in medical patients 
      at risk of venous thromboembolism.
PG  - 810-20
AB  - A decision-analytic model incorporating a Markov process to assess the 
      incremental cost and effectiveness of venous thromboembolism (VTE) prevention 
      strategies was used. Modeling was carried out using a hypothetical cohort of 
      medical patients at risk of VTE. The model compared clinical effectiveness 
      (primary and recurrent VTE, death), safety (adverse events), and direct medical 
      costs between patients receiving enoxaparin prophylaxis, unfractionated heparin 
      (UFH) prophylaxis, and no prophylaxis (n = 10,000 for each arm). Monte Carlo 
      simulation was performed to identify changes in inputs that would affect the 
      results. The estimated incidence ofVTE at two years (including recurrent VTE) was 
      6.8% with enoxaparin prophylaxis, 7.9% with UFH prophylaxis, and 17.9% with no 
      prophylaxis. Two-year mortality occurred in 15.7% of enoxaparin patients and 
      16.0% of UFH patients, with the incidences of major bleeding in these groups 
      being 0.7% and 1.2%, respectively. However, both enoxaparin and UFH prophylaxis 
      were associated with higher rates of major bleeds than no prophylaxis (0.6%). 
      Total average costs per patient were (US dollars) $1,264 (for enoxaparin 
      prophylaxis, $1,585 for UFH prophylaxis, and $2,245 for no prophylaxis). No 
      realistic parameter changes resulted in enoxaparin prophylaxis being more costly 
      than UFH prophylaxis. For the healthcare payer, considering all direct medical 
      costs associated with VTE up to two years after an admission for acute illness, 
      prophylaxis with enoxaparin was more effective and less costly than UFH. This 
      identifies enoxaparin as a potentially favorable VTE prophylaxis regimen compared 
      with UFH and no prophylaxis in at-risk medical patients.
FAU - Deitelzweig, Steven B
AU  - Deitelzweig SB
AD  - System Department Chair of Hospital Medicine, 1514 Jefferson Hwy, New Orleans, LA 
      70121, USA. sdeitelzweig@ochsner.org
FAU - Becker, Russ
AU  - Becker R
FAU - Lin, Jay
AU  - Lin J
FAU - Benner, Josh
AU  - Benner J
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - Germany
TA  - Thromb Haemost
JT  - Thrombosis and haemostasis
JID - 7608063
RN  - 0 (Anticoagulants)
RN  - 0 (Enoxaparin)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - *Anticoagulants/adverse effects/economics/therapeutic use
MH  - Cost-Benefit Analysis
MH  - Direct Service Costs
MH  - Drug Costs
MH  - *Enoxaparin/adverse effects/economics/therapeutic use
MH  - *Health Care Costs
MH  - Hemorrhage/chemically induced/economics
MH  - *Heparin/adverse effects/economics/therapeutic use
MH  - Hospital Costs
MH  - Humans
MH  - Insurance, Health, Reimbursement
MH  - Markov Chains
MH  - Models, Economic
MH  - Recurrence
MH  - Reproducibility of Results
MH  - Risk Assessment
MH  - Risk Factors
MH  - Treatment Outcome
MH  - *Venous Thromboembolism/economics/etiology/mortality/prevention & control
EDAT- 2008/11/08 09:00
MHDA- 2008/12/23 09:00
CRDT- 2008/11/08 09:00
PHST- 2008/11/08 09:00 [pubmed]
PHST- 2008/12/23 09:00 [medline]
PHST- 2008/11/08 09:00 [entrez]
AID - 08110810 [pii]
PST - ppublish
SO  - Thromb Haemost. 2008 Nov;100(5):810-20.