Deep vein thrombosis: outpatient anticoagulation was cheaper than inpatient.

Clinical bottom line (level 1b)

In patients with deep vein thrombosis, low molecular weight heparin and warfarin given as outpatients was equally effective and safe as heparin and warfarin given as inpatients.
In patients with deep vein thrombosis, low molecular weight heparin and warfarin given as outpatients was cheaper than heparin and warfarin given as inpatients.

van den Belt et al: Thrombosis and Haemostasis 1998; 79: 259-263
Koopman et al: New England Journal of Medicine 1996; 334: 682-687

Expires February 2003

The study

cost-effectiveness
Setting: nine acute hospitals in Europe, Australia and New Zealand

multicentred randomised control trial of patients with deep vein thrombosis and treated with low molecular weight heparin as outpatients or unfractionated heparin as inpatients. All patients received warfarin

Viewpoint: third party, eg. health service purchaser

Benefit assessment: recurrent DVT

Resources and costs: average resource allocation

Sensitivity analysis: multiple factors (not detailed)

The evidence

intervention	cost
unfractionated heparin	8609 Dutch gilders
low molecular weight heparin	3081 Dutch gilders

Effect of sensitivity analysis: There was no change following the sensitivity analysis.

Citation

van den Belt AG, Bossuy PMM, Prins MH, et al: Replacing inpatient care by outpatient care in the treatment of deep venous thrombosis- an economic evaluation.. Thrombosis and Haemostasis 1998; 79: 259-263
Koopman MM, et al: Treatment of venous thrombosis with intravenous unfractionated heparin administered in the hospital as compared with subcutaneous low-molecular-weight heparin administered at home.. New England Journal of Medicine 1996; 334: 682-687

Contributor: Chris Ball and Clare Wotton, May 2000
Reviewer: Alex Gallus

_{Clinical Question.}

_Patient	_{deep vein thrombosis}
_{Intervention or Exposure}	_LMWH
_Comparison	_{unfractionated heparin}
_Outcome	_{cost-effectiveness}