PMID- 20699258
OWN - NLM
STAT- MEDLINE
DCOM- 20120119
LR  - 20110929
IS  - 1938-2723 (Electronic)
IS  - 1076-0296 (Linking)
VI  - 17
IP  - 5
DP  - 2011 Oct
TI  - Low-molecular-weight heparin versus unfractionated heparin for prophylaxis of 
      venous thromboembolism in medicine patients--a pharmacoeconomic analysis.
PG  - 454-65
LID - 10.1177/1076029610376935 [doi]
AB  - BACKGROUND: Prevention of in-hospital venous thromboembolism (VTE) is identified 
      internationally as a priority to improve patient safety. Advocated alternatives 
      include low-dose unfractionated heparin (UFH) or low-molecular-weight heparin 
      (LMWH). Although LMWHs are as effective as UFH, less frequent administration and 
      potentially safer adverse effect profile associated with LMWHs might off-set 
      greater drug acquisition costs. The objective of this study was to determine the 
      most cost-effective thromboprophylaxis strategy for hospitalized medicine 
      patients and specific subgroups in Canada. METHODS: A decision-analytic model 
      assessed costs and outcomes of LMWH compared to UFH for thromboprophylaxis in 
      at-risk hospitalized medicine patients from an institutional perspective. The 
      outcome of interest was the incremental cost-effectiveness ratio (ICER) for 
      preventing deep vein thrombosis (DVT) and combined untoward events (pulmonary 
      embolism [PE], major bleed, and death). The time horizon of the model was the 
      hospital stay. RESULTS: In the base-case analysis, LMWH thromboprophylaxis 
      resulted in higher costs ($7.40), but 3.6 and 1.1 fewer DVT and untoward events 
      per 1000 patients, respectively, with associated ICERs of $2042 and $6832. 
      Results remained predominantly stable when alternative assumptions were evaluated 
      in the sensitivity analysis. Low-molecular-weight heparin had the most favorable 
      economic profile in patients with a history of DVT. In the probabilistic 
      sensitivity analysis, in 33% of simulations LMWH was less costly and more 
      effective, whereas the reverse was true for UFH only in 13% of simulations. 
      CONCLUSIONS: Low-molecular-weight heparin administration is a cost-effective 
      alternative for thromboprophylaxis strategy in Canadian hospitalized medicine 
      patients.
FAU - Wilbur, Kerry
AU  - Wilbur K
AD  - College of Pharmacy, Qatar University, Doha, Qatar. kwilbur@qu.edu.qa
FAU - Lynd, L D
AU  - Lynd LD
FAU - Sadatsafavi, M
AU  - Sadatsafavi M
LA  - eng
PT  - Comparative Study
PT  - Journal Article
DEP - 20100810
PL  - United States
TA  - Clin Appl Thromb Hemost
JT  - Clinical and applied thrombosis/hemostasis : official journal of the 
      International Academy of Clinical and Applied Thrombosis/Hemostasis
JID - 9508125
RN  - 0 (Fibrinolytic Agents)
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Canada
MH  - Costs and Cost Analysis
MH  - *Fibrinolytic Agents/economics/therapeutic use
MH  - *Heparin/economics/therapeutic use
MH  - *Heparin, Low-Molecular-Weight/economics/therapeutic use
MH  - Hospitalization/economics
MH  - Humans
MH  - Male
MH  - *Models, Theoretical
MH  - Risk Factors
MH  - Venous Thromboembolism/*economics/*prevention & control
EDAT- 2010/08/12 06:00
MHDA- 2012/01/20 06:00
CRDT- 2010/08/12 06:00
PHST- 2010/08/12 06:00 [entrez]
PHST- 2010/08/12 06:00 [pubmed]
PHST- 2012/01/20 06:00 [medline]
AID - 1076029610376935 [pii]
AID - 10.1177/1076029610376935 [doi]
PST - ppublish
SO  - Clin Appl Thromb Hemost. 2011 Oct;17(5):454-65. doi: 10.1177/1076029610376935. 
      Epub 2010 Aug 10.