Treatment of proximal vein thrombosis with subcutaneous low-molecular- weight heparin vs intravenous heparin: An economic perspective

Background: Subcutaneous low-molecular-weight heparin is at least as effective and safe as classic intravenous heparin therapy for the treatment of proximal vein thrombosis. Anticoagulant monitoring is not required with low-molecular-weight heparin. Objective: To perform an economic evaluation of these therapeutic approaches by comparing cost and effectiveness. Patients and Methods: A randomized trial in 432 patients with proximal vein thrombosis that compared intravenous heparin and low-molecular-weight heparin with objective documentation of clinical outcomes provided the opportunity to perform an analysis of cost-effectiveness to rank these alternative therapies in terms of both their cost and effectiveness. The economic viewpoint of this analysis was that of a third-party payer (ie, a ministry of health in Canada or an insurance company in the United States). Results: In the intravenous heparin-treated group, the cost incurred for 100 patients was $414 655 (Canadian dollars) or $375 836 (US dollars), with a frequency of objectively documented venous thromboembolism of 6.9%. In the low-molecular weight heparin-treated group, the cost incurred for 100 patients was $399 403 (Canadian dollars) or $335 687 (US dollars), with a frequency of objectively documented venous thromboembolism of 2.8%, thus providing a cost saving of $15 252 (Canadian dollars) or $40 149 (US dollars). Multiple sensitivity analyse were performed, and these procedures did not alter the findings of the study. Conclusions: The findings indicate that low-molecular-weight heparin therapy is at least as effective and safe but less costly than intravenous heparin treatment. The potential for outpatient therapy in up to 37% of patients who are receiving low-molecular-weight heparin would substantially augment the cost saving.