Deep vein thrombosis: LMWH was more cost-effective than heparin.

Clinical bottom line (level 1b)

  1. In patients with proximal DVT, low molecular weight heparin was more cost-effective than iv heparin.
Hull et al: Archives of Internal Medicine 1997; 157: 289-294
Expires May 2003

The study

cost-effectiveness analysis
Setting: teaching hospitals, USA and Canada

double blind randomised controlled trial (American-Canadian Thrombosis Study). 432 patients with proximal deep venous thrombosis diagnosed by venogram, received iv heparin, followed by warfarin titred to INR 2.0-3.0 for three months, or s/c low molecular weight heparin, followed by warfarin titred to INR 2.0-3.0 for three months.

  • Viewpoint: third party, eg. HMO or NHS purchaser
  • Benefit assessment: recurrent venous thromboembolism, bleed or death
  • Resources and costs: actual costs (1992 $) for hospitals participating in trial- drug treatment and cost of diagnosis and treatment if DVT present, and treatment complications
  • Sensitivity analysis: varied cost of treatment, diagnosis and treatment of recurrent VTE, treatment of bleeding, days in hospital, physicians' costs, treating all possible patients as out-patients (37%)

    • The evidence

    intervention cost
    cost per in-patient with iv heparin $3758
    cost per in-patient with LMWH $3357
    ( saving of $401 )

    Effect of sensitivity analysis: There was no change following the sensitivity analysis.
    • If all possible patients were treated as out-patients, the cost would be $2845- a saving of $913 per patient.

    Comments

    1. In USA, if the cost of LMWH increased 5.8 times, then both treatments would be equally cost-effective. This is unlikely to occur in the near future.

    Citation

    1. Hull RD, Raskob GE, Rosenbloom D, et al: Treatment of proximal vein thrombosis with subcutaneous low-molecular-weight heparin versus intravenous heparin: an economic perspective.. Archives of Internal Medicine 1997; 157: 289-294
    Contributor: Chris Ball and Clare Wotton, May 2000
    Reviewer: Clive Kearon.

    Clinical Question.
    Patient DVT
    Intervention or Exposure low molecular weight heparin
    Comparison iv heparin
    Outcome cost-effectiveness