PMID- 30319954
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220321
IS  - 2231-0770 (Print)
IS  - 2249-4464 (Electronic)
IS  - 2231-0770 (Linking)
VI  - 8
IP  - 4
DP  - 2018 Oct-Dec
TI  - Cost reduction associated with heparin-induced thrombocytopenia panel ordering 
      for enoxaparin versus heparin for prophylactic and therapeutic use: A 
      retrospective analysis in a community hospital setting.
PG  - 133-138
LID - 10.4103/ajm.AJM_78_18 [doi]
AB  - BACKGROUND: Most hospitals still use unfractionated heparin (UFH) as the primary 
      agent for venous thromboembolism (VTE) prophylaxis in the hospital setting due to 
      ease of use and insignificant cost. However, the risk of heparin-induced 
      thrombocytopenia (HIT) has led some groups to favor other options for therapeutic 
      and prophylactic anticoagulation. This is particularly relevant in light of 
      recent data demonstrating a lower rate of HIT in patients receiving enoxaparin 
      compared with UFH. This study examines the cost-effectiveness of enoxaparin, 
      compared to UFH for prophylactic and therapeutic usage in hospitals. METHODS: We 
      conducted a retrospective chart review of patients who underwent HIT panel 
      testing at the Inspira Health Network, Vineland campus (an approximately 
      262-bedded community hospital located in southern New Jersey that services a 
      population of approximately 61,050) from the period of April 1, 2015 through 
      December 31, 2016. The starting date represents the time from which enoxaparin 
      became the primary alternative anticoagulant available at this hospital. Records 
      of the total usage and cost of UFH and enoxaparin for the specified time period 
      were collected from the hospital pharmacy database for evaluation, as were 
      records of HIT panels. The information was analyzed to determine the frequency of 
      HIT panel testing orders for patients receiving UFH versus those receiving 
      enoxaparin. Annual cost-savings for the hospital were extrapolated using the 
      comparative incidence of HIT panels and associated costs, including increased 
      length of stay, hematology/oncology consultation, use of an alternative 
      anticoagulant, critical bleeding requiring transfusion, and complications of 
      HIT-associated thrombosis. These variables were multiplied by the incidence rate 
      for each specified drug and usage to determine the daily cost for each drug. 
      RESULTS: The use of enoxaparin did not result in a significant decrease in the 
      ordering of HIT panels in the hospital, with a relative rate ratio of 0.948 (95% 
      confidence interval: 0.336, 2.21). When the data were stratified to examine 
      prophylactic and therapeutic anticoagulation, there was a marked difference in 
      the frequency of HIT testing. The rate ratio of HIT panel orders for patients 
      receiving therapeutic enoxaparin rather than intravenous (IV) UFH was 0.118 
      (0.006, 0.625). These numbers were used to extrapolate the total daily cost of 
      enoxaparin compared with IV UFH; therapeutic enoxaparin cost $30.66, while IV UFH 
      cost $162.30. IV UFH use was associated with a higher incidence rate of HIT panel 
      orders, and consequently a higher daily cost due to the likelihood of increased 
      length of stay, use of alternative anticoagulation, bleeding requiring 
      transfusion, and request for expert consultation. CONCLUSION: In this study, the 
      use of enoxaparin was associated with a significant cost-saving over IV UFH when 
      used for therapeutic anticoagulation, but this cost saving was not observed for 
      prophylactic anticoagulation.
FAU - Menon, Harry
AU  - Menon H
AD  - Departments of Medicine and Pharmacy, Inspira Health Network, Vineland, New 
      Jersey, USA.
FAU - Pillai, Adip
AU  - Pillai A
AD  - Departments of Medicine and Pharmacy, Inspira Health Network, Vineland, New 
      Jersey, USA.
FAU - Aussenberg-Rodriguez, Jeanine
AU  - Aussenberg-Rodriguez J
AD  - Departments of Medicine and Pharmacy, Inspira Health Network, Vineland, New 
      Jersey, USA.
FAU - Ambrose, John
AU  - Ambrose J
AD  - Departments of Medicine and Pharmacy, Inspira Health Network, Vineland, New 
      Jersey, USA.
FAU - Youssef, Irini
AU  - Youssef I
AD  - Department of Medicine, Suny Downstate Medical School, Brooklyn, New York, USA.
FAU - Griffiths, Elizabeth A
AU  - Griffiths EA
AD  - Department of Medicine, Leukemia Section, Roswell Park Cancer Institute, Buffalo, 
      New York, USA.
FAU - Al Ustwani, Omar
AU  - Al Ustwani O
AD  - Departments of Medicine and Pharmacy, Inspira Health Network, Vineland, New 
      Jersey, USA.
LA  - eng
PT  - Journal Article
PL  - Germany
TA  - Avicenna J Med
JT  - Avicenna journal of medicine
JID - 101584155
PMC - PMC6178568
OTO - NOTNLM
OT  - Anticoagulation
OT  - heparin-induced thrombocytopenia
OT  - low molecular weight heparin
COIS- There are no conflicts of interest.
EDAT- 2018/10/16 06:00
MHDA- 2018/10/16 06:01
PMCR- 2018/10/01
CRDT- 2018/10/16 06:00
PHST- 2018/10/16 06:00 [entrez]
PHST- 2018/10/16 06:00 [pubmed]
PHST- 2018/10/16 06:01 [medline]
PHST- 2018/10/01 00:00 [pmc-release]
AID - AJM-8-133 [pii]
AID - 10.4103/ajm.AJM_78_18 [doi]
PST - ppublish
SO  - Avicenna J Med. 2018 Oct-Dec;8(4):133-138. doi: 10.4103/ajm.AJM_78_18.