November 3rd, 2014

Economic Study Finds VTE Prophylaxis with Low-Molecular-Weight Heparin Cost Effective

Critically ill patients in the hospital are at high risk for developing venous thromboembolism (VTE). The 2011 PROTECT trial compared the two most common drug strategies used to prevent VTE — unfractionated heparin (UFH) and dalteparin, a low-molecular-weight heparin (LMWH) —  and found no difference between the two groups in the primary endpoint of the trial, leg deep-vein thrombosis.

But PROTECT did turn up a significant reduction in the dalteparin group in the important secondary endpoints of pulmonary embolism (PE) and heparin-induced thrombocytopenia (HIT). Now a prespecified economic analysis of PROTECT, published in JAMA, indicates that use of LMWH, though it is more expensive than UFH, may lead to lower hospital costs due to the reduction in PE and HIT.

Hospital costs per patient patient were $39,508 in the LMWH group and  $40,805 in the UFH group. The cost effectiveness of LMWH remained significant even after assuming large increases in the cost of dalteparin or reductions in the cost of UFH. The results were applicable to both higher-spending and lower-spending health care systems. LMWH was both more effective and less costly in 78% of the simulations performed by the PROTECT investigators.

“These findings are important for the care of critically ill patients because they provide a cost-minimization rationale that complements clinical effectiveness knowledge from PROTECT. For example, if an ICU with 1,000 medical-surgical admissions per year uses UFH instead of LMWH for prevention of VTE, the annual incremental cost may be between $1,000,000 to $1,500,000 with similar or worse clinical outcomes, despite the individual drug cost of UFH being $4 to $5 less per day,” the authors wrote.


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