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Low-molecular-weight heparin more cost-effective than unfractionated heparin for VTE prevention
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For prophylaxis of venous thromboembolism in critically ill patients, use of low–molecular-weight heparin was more cost-effective than use of unfractionated heparin, according to a new analysis.
Researchers measured costs, effects and incremental cost-effectiveness of the low–molecular-weight heparin dalteparin (Fragmin, Pfizer) as compared with unfractionated heparin among 2,344 patients from the PROTECT trial. The results were presented at the Critical Care Canada Forum and published in JAMA.
Robert A. Fowler, MDCM, MS, and colleagues found a slight savings in hospital costs per patient associated with dalteparin ($39,508 vs. $40,805; incremental cost, –$1,297; P=.41).
However, in 78% of simulations, a strategy using dalteparin was the most effective and least costly.
When the researchers conducted sensitivity analyses, they determined that a strategy using dalteparin remained least costly unless the acquisition cost of dalteparin increased from $8 per dose to $179 per dose. The results were consistent among higher-spending health care systems and lower-spending systems.
The researchers found no threshold at which lowering the acquisition cost of unfractionated heparin would favor prophylaxis with unfractionated heparin.
“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,” Fowler, from Sunnybrook Health Sciences Centre, University of Toronto, and colleagues wrote. According to the study background, the PROTECT trial found no difference in the primary endpoint of leg deep vein thrombosis between patients assigned dalteparin and those assigned unfractionated heparin, but there was a reduced rate of pulmonary embolus and heparin-induced thrombocytopenia in the dalteparin group.
“For example, if an ICU with 1,000 medical-surgical admissions uses [unfractionated heparin] instead of [low–molecular-weight heparin] for prevention of VTE, the annual incremental cost may be between $1 million to $1.5 million with similar or worse clinical outcomes, despite the individual drug cost of [unfractionated heparin] being $4 to $5 less per day,” the researchers wrote.
For more information:
Fowler RA. Plenary New Data. Presented at: Critical Care Canada Forum; Oct. 29-Nov. 1, 2014; Toronto.
Fowler RA. JAMA. 2014;doi:10.1001/jama.2014.15101.
Disclosure: See the full study for a list of funding sources and the researchers’ relevant financial disclosures.