Cost Effectiveness of Enoxaparin as Prophylaxis against Venous Thromboembolic Complications in Acutely Ill Medical Inpatients

Schädlich, Peter K.; Kentsch, M.; Weber, Manfred; Kämmerer, Wolfgang; Brecht, Josef Georg; Nadipelli, Vijay; Huppertz, E.

doi:10.2165/00019053-200624060-00005

Cited by 23 publications

(41 citation statements)

References 36 publications

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“…One assumed that 3% of patients receiving UFH would develop HIT; 13 something we did not observe. At least 3 additional analyses, [14][15][16] all funded by the manufacturer of enoxaparin, assumed that LMWH was both more effective and safer than UFH. We found that adjusted costs were similar or slightly lower with UFH than LMWH.…”

Section: Discussionmentioning

confidence: 99%

Comparative effectiveness of low‐molecular‐weight heparin versus unfractionated heparin for thromboembolism prophylaxis for medical patients

Rothberg

Pekow

Lahti³

et al. 2012

Journal of Hospital Medicine

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BACKGROUND:Both unfractionated heparin (UFH) and low‐molecular‐weight heparin (LMWH) are approved for venous thromboembolism (VTE) prophylaxis. Which agent is superior remains controversial.OBJECTIVE:To compare the effectiveness, complications, and costs of UFH and LMWH as VTE prophylaxis for hospitalized medical patients.DESIGN:Retrospective cohort.SETTING:Three hundred thirty‐three acute care facilities in 2004–2005.PATIENTS:Adults with 4 common medical diagnoses considered to carry moderate‐to‐high risk of VTE. Excluded were patients on warfarin or with hospital stays of ≤2 days. VTE prophylaxis was assessed from billing data.INTERVENTION:None.MEASUREMENTS:VTE, major bleeding or heparin‐induced thrombocytopenia, mortality, and cost.RESULTS:Of 32,104 patients who received prophylaxis, 55% received LMWH and the remainder received UFH. The hospital where the patient obtained care was the strongest predictor of receiving LMWH. VTE was observed in 163 (0.51%) patients; complications, followed by stopping therapy, were rare (<0.2%). In analysis adjusted for the propensity for UFH and other covariates, patients treated with UFH had an odds ratio for VTE of 1.04 (95% confidence interval [CI] 0.76 to 1.43) compared to LMWH. In a grouped treatment model, the odds of VTE with UFH was 1.14 (95% CI 0.72 to 1.81). Adjusted odds of bleeding with UFH compared to LMWH were 1.64 (95% CI 0.50 to 5.33), adjusted odds of complications followed by stopping prophylaxis were 2.84 (95% CI 1.43 to 45.66), and adjusted cost ratio was 0.97 (95% CI 0.90 to 1.05).CONCLUSIONS:For VTE prophylaxis, the effectiveness and cost of LMWH and UFH are similar, but LMWH is associated with fewer complications. Journal of Hospital Medicine 2012;. © 2012 Society of Hospital Medicine

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Section: Discussionmentioning

confidence: 99%

Comparative effectiveness of low‐molecular‐weight heparin versus unfractionated heparin for thromboembolism prophylaxis for medical patients

Rothberg

Pekow

Lahti³

et al. 2012

Journal of Hospital Medicine

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“…or t.i.d. for UFH versus once daily), the costs associated with the diagnosis and treatment of heparin-associated thrombocytopenia (HIT) (36,37), and economic analyses performed in Europe, which have demonstrated cost savings from the use of LMWH over UFH that are similar to those found in the United States (38).…”

Section: Efficacy and Safety Of Available Anticoagulantsmentioning

confidence: 97%

“…The IMPROVE study observed that intermittent pneumatic compression was the most common form of VTE prophylaxis utilized in the United States for the medically ill hospitalized patient, although it was used very rarely in other countries (22% vs. 0.2%, respectively) (38). There was variable use of graduated elastic stockings for VTE prophylaxis in the United States and other participating countries (3% vs. 7%, respectively) (38).…”

Section: Mechanical Interventions For Vte Prophylaxis In Medically Ilmentioning

confidence: 99%

“…There was variable use of graduated elastic stockings for VTE prophylaxis in the United States and other participating countries (3% vs. 7%, respectively) (38). The National Comprehensive Cancer Network (NCCN) advocates that continuous mechanical prophylaxis with sequential compression devices (SCDs) should be applied to all hospitalized cancer patients for primary VTE prophylaxis (46).…”

Section: Mechanical Interventions For Vte Prophylaxis In Medically Ilmentioning

confidence: 99%

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Prevention of Venous Thromboembolism in Hospitalized Medical Patients

Kessler

Andrew

2009

Cancer Investigation

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Venous thromboembolism (VTE) is a clinical disease entity which is manifested as deep venous thrombosis and/or pulmonary embolism. VTE presenting as pulmonary embolism (PE)is one of the leading causes of mortality and morbidity in the United States. Pulmonary embolism accounts for 5-10% of deaths in hospitalized patients, making VTE the most common preventable cause of in-hospital death. It appears that PE is more common in hospitalized medical patients than surgical patients, although medical patients are less likely to receive VTE prophylaxis. Up to 15% of hospitalized medical patients who do not receive thromboprophylaxis will develop symptomatic VTE. Fatal PE also seems to occur more frequently in medical rather than surgical patients. The economic burden of VTE is substantial. In 2004, the cost of a VTE occurring in hospital added over $18,000 USD to the median cost of an individual hospitalization and increased the length of stay by a median of almost 10 days. The costs associated with long-term management and chronic complications of VTE that arise after discharge from hospital are also significant. VTE prophylaxis is underused or applied incorrectly in medically ill hospitalized patients. This trend is certain to improve as external regulatory forces monitor physician practices and clinical outcomes. This review summarizes the large body of data on VTE risk factors, the efficacy and safety of pharmacologic and mechanical prophylaxis, and consensus guideline recommendations for primary in-hospital prophylaxis of medical patients.

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“…Active VTE prophylaxis is effective in preventing symptomatic VTE in at-risk hospitalized medical patients with significant reductions in any PE and fatal PE, a nonsignificant reduction in symptomatic DVT, and a nonsignificant increase in major bleeding [7]. As far as pharmocoeconomics is concerned, VTE prophylaxis with low-molecular-weight heparin has been shown to be cost-effective compared with no pharmacological prophylaxis in immobilised acutely ill medical inpatients [8]. However despite the evidence of the benefit of prophylaxis, VTE prophylaxis remains underused [2,9].…”

Section: Introductionmentioning

confidence: 99%

Improved venous thromboembolism prophylaxis by pharmacist-driven interventions in acutely ill medical patients in Belgium

2014

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Cost Effectiveness of Enoxaparin as Prophylaxis against Venous Thromboembolic Complications in Acutely Ill Medical Inpatients

Abstract: Results of this evaluation suggest that, in immobilised acutely ill medical inpatients, ENOX may offer hospitals in Germany a very cost-effective option for thromboprophylaxis compared with NPP and a cost-saving alternative compared with LDUFH.

Cited by 23 publications

References 36 publications

Comparative effectiveness of low‐molecular‐weight heparin versus unfractionated heparin for thromboembolism prophylaxis for medical patients

Comparative effectiveness of low‐molecular‐weight heparin versus unfractionated heparin for thromboembolism prophylaxis for medical patients

Prevention of Venous Thromboembolism in Hospitalized Medical Patients

Improved venous thromboembolism prophylaxis by pharmacist-driven interventions in acutely ill medical patients in Belgium

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