Venous thromboembolism: long-term LMWH was not very cost-effective compared with warfarin

Clinical bottom line (level 1b)

  1. Treating patients following an episode of venous thromboembolism with long-term LMWH compared with warfarin was not particularly cost-effective, though it may be more so in older patients or if LMWH is relatively cheap.
Marchetti et al: Am J Med 2001; 111 : 130-139
Expires May 2004

The study

Cost-effectiveness study based on a decision tree comparing enoxaparin 40 mg once daily with warfarin for 3 months.
Setting: community/ anticoagulation clinic

A systematic review and meta-analysis of all longitudinal studies assessing secondary prophylaxis of venous thromboembolism using a LMWH or warfarin on recurrent venous thromboembolism and bleeding. Patient utilities were obtained from the literature for these outcomes.

  • Viewpoint: society
  • Benefit assessment: quality-adjusted life-year (QALY)
  • Resources and costs: In US dollars: costs of drugs, blood tests, clinical appointments and supplies, and a hospital admission for stroke; indirect costs including lost income due to absence from work during hsoptial stay and 1 month after a venous thromboembolic event, for 1 week following a minor bleed and for 6 months after a haemorrhagic stroke. Costs were also recalculated using US costs.
  • Sensitivity analysis: Efficacy and safety of LMWH was varied, as was the average patient age, and the presence of rebound recurrence of venous thromboembolism on stopping LMWH.

    The evidence

    intervention cost
    LMWH v. warfarin (USA) $28231
    LMWH v. warfarin (Italy) $6583

    Effect of sensitivity analysis: Adding in the effect of rebound increased costs per QALY (Italy) to $53166 and (USA) $177166. Cost-effectiveness also rose with increasing cost of LMWH and younger patient age.

    Citation

    1. Marchetti M, Pistorio A, Barone M, et al: low-molecular-weight heparin versus warfarin for secondary prophylaxis of venous thromboembolism: a cost-effectiveness analysis. Am J Med 2001; 111 : 130-139
    Search Terms: from ACP Journal Club other articles noted
    Contributor: Chris Ball, May 2002
    Reviewer:

    Clinical Question.
    Patient venous thromboembolism
    Intervention or Exposure cost of LMWH v. warfarin
    Outcome QALY
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