| Cost-effectiveness of low-molecular-weight heparin and unfractionated heparin in treatment of deep vein thrombosis. | |
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MedLine Citation:
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PMID: 9834718 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Acute deep vein thrombosis has traditionally been treated with unfractionated heparin (UFH), administered intravenously, but low-molecular-weight heparins (LMWH), administered subcutaneously, have recently become available. The authors sought to determine which therapy was more cost-effective for inpatient and outpatient treatment of deep vein thrombosis. METHODS: An incremental cost-effectiveness analysis based on a decision tree was performed for 4 treatment strategies for deep vein thrombosis. Rate of major hemorrhage while receiving heparin, rate of recurrence of venous thromboembolism 3 months after treatment and mortality rate 3 months after treatment were determined by meta-analysis. Costs for the UFH therapy were prospectively collected by a case-costing accounting system for 105 patients with deep vein thrombosis treated in fiscal year 1995/96. The costs for LMWH therapy were modelled, and cost-effectiveness was determined by decision analysis. RESULTS: Meta-analysis revealed a mean difference in risk of hemorrhage of -1.1% (95% confidence interval [CI] -2.4% to 0.3%), a mean difference in risk of recurrence of venous thromboembolism of -2.6% (95% CI -4.5% to -0.7%) and a mean difference in risk of death of -1.9% (95% CI -3.6% to -0.4%), all in favour of subcutaneous unmonitored administration of LMWH. The cost to treat one inpatient was $2993 for LMWH and $3048 for UFH. Even more would be saved if LMWH was delivered on an outpatient basis (cost of $1641 per patient). The cost-effectiveness analysis showed that LMWH in any treatment setting is more cost effective than UFH. A sensitivity analysis demonstrated the robustness of this conclusion. INTERPRETATION: Treatment of deep vein thrombosis with LMWH is more cost effective than treatment with UFH in both inpatient and outpatient settings. |
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Authors:
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M Rodger; C Bredeson; P S Wells; J Beck; B Kearns; L B Huebsch |
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Publication Detail:
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Type: Journal Article; Meta-Analysis; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne Volume: 159 ISSN: 0820-3946 ISO Abbreviation: CMAJ Publication Date: 1998 Oct |
Date Detail:
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Created Date: 1998-12-11 Completed Date: 1998-12-11 Revised Date: 2009-11-18 |
Medline Journal Info:
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Nlm Unique ID: 9711805 Medline TA: CMAJ Country: CANADA |
Other Details:
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Languages: eng Pagination: 931-8 Citation Subset: AIM; IM; N |
Affiliation:
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Department of Medicine, University of Ottawa, Ont. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Canada Cost-Benefit Analysis Decision Trees Drug Costs* Heparin / economics*, therapeutic use Heparin, Low-Molecular-Weight / economics*, therapeutic use Humans Treatment Outcome Venous Thrombosis / drug therapy*, economics* |
| Chemical | |
Reg. No./Substance:
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0/Heparin, Low-Molecular-Weight; 9005-49-6/Heparin |
| Comments/Corrections | |
Comment In:
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ACP J Club. 1999 Mar-Apr;130(2):53 |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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