PMID- 9834718
OWN - NLM
STAT- MEDLINE
DCOM- 19981211
LR  - 20181113
IS  - 0820-3946 (Print)
IS  - 1488-2329 (Electronic)
IS  - 0820-3946 (Linking)
VI  - 159
IP  - 8
DP  - 1998 Oct 20
TI  - Cost-effectiveness of low-molecular-weight heparin and unfractionated heparin in 
      treatment of deep vein thrombosis.
PG  - 931-8
AB  - BACKGROUND: Acute deep vein thrombosis has traditionally been treated with 
      unfractionated heparin (UFH), administered intravenously, but 
      low-molecular-weight heparins (LMWH), administered subcutaneously, have recently 
      become available. The authors sought to determine which therapy was more 
      cost-effective for inpatient and outpatient treatment of deep vein thrombosis. 
      METHODS: An incremental cost-effectiveness analysis based on a decision tree was 
      performed for 4 treatment strategies for deep vein thrombosis. Rate of major 
      hemorrhage while receiving heparin, rate of recurrence of venous thromboembolism 
      3 months after treatment and mortality rate 3 months after treatment were 
      determined by meta-analysis. Costs for the UFH therapy were prospectively 
      collected by a case-costing accounting system for 105 patients with deep vein 
      thrombosis treated in fiscal year 1995/96. The costs for LMWH therapy were 
      modelled, and cost-effectiveness was determined by decision analysis. RESULTS: 
      Meta-analysis revealed a mean difference in risk of hemorrhage of -1.1% (95% 
      confidence interval [CI] -2.4% to 0.3%), a mean difference in risk of recurrence 
      of venous thromboembolism of -2.6% (95% CI -4.5% to -0.7%) and a mean difference 
      in risk of death of -1.9% (95% CI -3.6% to -0.4%), all in favour of subcutaneous 
      unmonitored administration of LMWH. The cost to treat one inpatient was $2993 for 
      LMWH and $3048 for UFH. Even more would be saved if LMWH was delivered on an 
      outpatient basis (cost of $1641 per patient). The cost-effectiveness analysis 
      showed that LMWH in any treatment setting is more cost effective than UFH. A 
      sensitivity analysis demonstrated the robustness of this conclusion. 
      INTERPRETATION: Treatment of deep vein thrombosis with LMWH is more cost 
      effective than treatment with UFH in both inpatient and outpatient settings.
FAU - Rodger, M
AU  - Rodger M
AD  - Department of Medicine, University of Ottawa, Ont.
FAU - Bredeson, C
AU  - Bredeson C
FAU - Wells, P S
AU  - Wells PS
FAU - Beck, J
AU  - Beck J
FAU - Kearns, B
AU  - Kearns B
FAU - Huebsch, L B
AU  - Huebsch LB
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Research Support, Non-U.S. Gov't
PL  - Canada
TA  - CMAJ
JT  - CMAJ : Canadian Medical Association journal = journal de l'Association medicale 
      canadienne
JID - 9711805
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 9005-49-6 (Heparin)
SB  - IM
CIN - ACP J Club. 1999 Mar-Apr;130(2):53
MH  - Canada
MH  - Cost-Benefit Analysis
MH  - Decision Trees
MH  - *Drug Costs
MH  - Heparin/*economics/therapeutic use
MH  - Heparin, Low-Molecular-Weight/*economics/therapeutic use
MH  - Humans
MH  - Treatment Outcome
MH  - Venous Thrombosis/*drug therapy/*economics
PMC - PMC1229738
EDAT- 1998/12/03 00:00
MHDA- 1998/12/03 00:01
PMCR- 1998/10/20
CRDT- 1998/12/03 00:00
PHST- 1998/12/03 00:00 [pubmed]
PHST- 1998/12/03 00:01 [medline]
PHST- 1998/12/03 00:00 [entrez]
PHST- 1998/10/20 00:00 [pmc-release]
PST - ppublish
SO  - CMAJ. 1998 Oct 20;159(8):931-8.