The Economic Impact of Treating Deep Vein Thrombosis with Low-Molecular-Weight Heparin: Outcome of Therapy and Health Economy Aspects

Abstract

Subcutaneous low-molecular-weight heparin (LMWH) is at least as safe and effective as classical intravenous heparin therapy for the treatment of proximal vein thrombosis. Anticoagulant monitoring and intravenous administration are not required with LMWH treatment, therefore this therapy may offer economic advantages. An economic evaluation of these therapeutic approaches was performed comparing the costs and effectiveness. The evaluation was aimed at helping decision-makers to maximize the health of the population served, subject to available resources. The American-Canadian Thrombosis Study was a multicentre, randomized, double-blind clinical trial that compared treatment by initial continuous intravenous infusion of heparin (followed by 3 months of warfarin therapy) with a once-daily dose of subcutaneous LMWH, tinzaparin sodium (followed by 3 months of warfarin treatment) in patients with acute proximal deep vein thrombosis. In the LMWH-treated group, the cost incurred for 100 patients was $399,403 (Canadian) or $335,687 (US) with a frequency of objectively documented recurrent venous thromboembolism of 2.8%. In the intravenous heparin-treated group, the cost incurred for 100 patients was $414,655 (Canadian) or $375,836 (US), with a frequency of objectively documented recurrent venous thromboembolism of 6.9%. These results show a cost saving of $15,252 (Canadian) or $40,149 (US) with the use of LMWH. Multiple sensitivity analyses did not alter the findings of the study which indicated that LMWH therapy is at least as safe and effective but less costly than intravenous heparin treatment. The potential for outpatient therapy in up to 37% of patients who are receiving LMWH would substantially augment the cost-saving. The cost-effectiveness findings presented in this paper are based on the assumption that all costs are covered by a single payer. Outpatient management in many countries will shift the healthcare costs from the healthcare payer to the patient, increasing the economic burden to the patient.

Pathophysiology of Post-Thrombotic Syndrome: The Effect of Recurrent Venous Thrombosis and Inherited Thrombophilia

“…With its attendant mortality, PE is the most devastating complication of acute DVT. PE accounts for 200000 deaths each year in the United States (US), and the annual cost of the treatment is measured in billions of dollars [2,3].…”

Parnaparin: review of the literature

“…In uno studio farmacoeconomico condotto sulla base dei risultati di un ampio trial clinico secondo le prospettive del terzo pagante statunitense e canadese, la terapia con EBPM è risultata dominante rispetto alla terapia con ENF, ossia associata contemporaneamente a migliori esiti clinici ed economici, nonostante il superiore costo per l'acquisto del farmaco [42].…”

La tromboprofilassi post-chirurgica e la terapia del tromboembolismo venoso con eparine a basso peso molecolare: ruolo della bemiparina in una strategia di minimizzazione dei costi

“…In uno studio farmacoeconomico condotto con la prospettiva del terzo pagante sulla base dei risultati di un ampio trial clinico di terapia della trombosi venosa profonda, le EBPM sono risultate superiori a ENF sia clinicamente sia economicamente, nonostante il superiore costo d'acquisto del farmaco [21].…”