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Cost-Effectiveness of Dalteparin vs Unfractionated Heparin for the Prevention of Venous Thromboembolism in Critically Ill Patients
Study Questions:
What is the cost-effectiveness of low molecular weight heparin (LMWH) versus unfractionated heparin (UFH) for prophylaxis against venous thromboembolism (VTE) in critically ill patients?
Methods:
A prespecified, prospective economic analysis was conducted concurrently with the PROTECT (Prophylaxis for Thromboembolism in Critical Care Randomized Trial) study between May 2006 and June 2010. The PROTECT trial demonstrated similar rates of deep venous thrombosis, but lower rates of pulmonary embolism and heparin-induced thrombocytopenia in medical-surgical intensive care unit patients treated with LMWH dalteparin as compared to UFH. The economic analysis was performed from a health care payer perspective, following 2,344 patients across five countries. Simulations were performed, varying the difference in proportion of VTE and medication costs between LMWH and UFH.
Results:
Hospital costs per patient were $39,508 (interquartile range [IQR], $24,676-$71,431) for the 1,862 patients receiving LMWH compared to $40,805 (IQR, $24,393-$76,139) for the 1,862 patients receiving UFH. LMWH was the most effective and least costly treatment strategy in 78% of simulations. In sensitivity analysis, LMWH therapy was a less expensive approach unless LMWH cost increased from $8 to $179 per dose. There was no threshold at which lowering the acquisition cost of UFH favored its use over LMWH for VTE prophylaxis.
Conclusions:
The authors concluded that from a health care payer perspective, use of LMWH for VTE prophylaxis in critically ill medical-surgical patients was more effective, with similar or lower costs than UFH therapy.
Perspective:
This economic analysis of the PROTECT trial demonstrates clinical and cost-effectiveness for LMWH over UFH in critically ill medical-surgical patients in the intensive care unit. Although LMWH is often more expensive on a per-injection basis, the reduction in pulmonary embolism and heparin-induced thrombocytopenia drove the cost-effectiveness results in favor of LMWH therapy compared to UFH therapy. Patients are usually appreciative of the once-daily injections with LMWH instead of twice- or thrice-daily injections with UFH.
Keywords: Hospital Costs, Intensive Care Units, Anticoagulants, Heparin, Low-Molecular-Weight, Heparin, Venous Thromboembolism, Dalteparin, Critical Illness, Venous Thrombosis, Thrombocytopenia
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