Tinzaparin reduces health care resource use for anticoagulation in hemodialysis

Abstract

Anticoagulation is required during hemodialysis to prevent thrombus formation within the extracorporeal circuit. The low-molecular-weight heparin tinzaparin is more expensive than unfractionated heparin (UFH) in Canada but more convenient to administer. We conducted a time-and-motion study to test the hypothesis that tinzaparin may reduce nursing time and total health care costs compared with UFH. Data on health care resource use associated with anticoagulation during hemodialysis for chronic renal failure were collected at an academic hospital in Quebec. Nursing time was recorded for 8 nurses performing 16 dialysis sessions for 4 patients receiving tinzaparin and 4 receiving UFH (2 dialysis sessions per patient). Nurses had ≥ 1 year of experience supervising hemodialysis. We estimated total annual costs of nursing time and health care resources (anticoagulants, medical supplies, and laboratory testing) associated with anticoagulation. In sensitivity analyses, drug costs were varied ± 30% of their base-case values. Estimated annual nursing times per patient were 0.8 vs. 11.5 hours in the first year and 0.6 vs. 10.2 hours in subsequent years for tinzaparin vs. UFH, respectively. Annual drug costs per patient were CAD 898.56 for tinzaparin and 546.75 for UFH. Estimated total annual costs were CAD 1061.03 vs. 1012.71 in the first year and CAD 917.75 vs. 895.23 in subsequent years for tinzaparin vs. UFH, respectively. Use of tinzaparin was cost saving relative to UFH if tinzaparin price was reduced 30%. Most of the price differential between tinzaparin and UFH is offset by substantial time savings to nephrology nurses.

The rationale for the use of low molecular weight heparin for hemodialysis treatments

“…The costs of LMWHs vary not only from country to country, but can also vary from hospital to hospital within the same country, but over time the cost differential between LMHWs and UFH is falling. Despite potentially a higher cost, many studies have reported similar overall treatment costs when taking into account the ease of administration of a prefilled syringe compared to the costs and nursing time spent in setting up a UFH infusion . Although there is no simple bed side test of anticoagulation, due to the greater reliability of drug dosages compared to UFH, most centers simply adjust the dose according to clinical assessment of the extracorporeal circuit and time for the needle sites to stop bleeding.…”

“…Studies which have compared with LMWHs with UFH, have reported shorter needle site bleeding times post dialysis, with either similar or less circuit clotting and bleeding episodes than UFH, and improved urea clearances due to reduced dialyzer membrane fouling and fewer cases of heparin induced thrombocytopenia …”

“…In centers which used a single UFH bolus followed by an infusion, the additional nursing time for administering UFH was around 4 min per dialysis session, with additional costs for the syringe, needle and saline to set up the UFH infusion . Although the annual cost of tinzaparin was $898.56 per patient compared to $582.63 for UFH, the time saved amounted to Canadian $329.02, making LMWH similar to the overall cost of UFH . A UK study also reported parity, even though the LMWH was more expensive than the UFH (GBP 0.64 vs. 0.325).…”

Tissue plasminogen activator versus heparin for locking dialysis catheters: A systematic review

“…The use of heparin as a locking solution has been the standard of care in this era due to its efficacy, reasonable side effect profile, and cost-effectiveness. [24,25] In studies that used large central venous catheters for dialysis, heparin was shown to be superior to normal saline when used as a flush in dialysis catheters, keeping them more patent, decreasing the need of rt-PA to lyse formed clots within catheters, and improving catheter survival. [25][26][27][28][29] Conversely, some other studies showed that heparin flushed not to be different from normal saline; not to increase the duration of catheter use or to improve its functionality and may prolong aPTT significantly; [29,30] worth noting that these studies used smaller catheters either in peripheral intravenous catheters in children or as arterial catheters.…”

Comparison of oral and intravenous Alfacalcidol in chronic hemodialysis patients

“…Annual costs included drug price, medical supplies and nursing time and were extrapolated for the six-month study and nursing time evaluation. Cost for nursing time were calculated by multiplying nursing time by average hourly wage for nephrology nurses in Quebec, including social benefits, obtained from the Quebec Ministry of Health [17]. …”