تراپی کوتاه مدت با انوکساپارین و یا هپارین شکسته نشده برای ترومبوآمبولی وریدی در بیماران بستری: مطالعه بهره برداری و تجزیه و تحلیل به حداقل رساندن هزینه

Objectives To evaluate the direct costs of venous thromboembolism (VTE) treatment with unfractionated heparin (UFH) and low-molecular weight heparin, from the institutional perspective. Methods This is a real-world cohort study that included inpatients treated with UFH or enoxaparin for deep venous thromboembolism or pulmonary embolism in a tertiary public hospital. To estimate medical costs we computed the acquisition costs of drugs, supplies for administration, laboratory tests, and hospitalization cost according to the patient ward. Results One hundred sixty-seven patients aged 18 to 92 years were studied (50 treated with UFH and 117 with enoxaparin). The median of days in use of heparin was the same in both groups. Activated partial thromboplastin time was monitored in 98% of patients using UFH and 56.4% using enoxaparin. Nonstatistically significant differences were observed between groups in the number of bleeding events (10.0% and 9.4%; P = 1.00); blood transfusion (2.0% and 2.6%; P = 1.00); death (8.0% and 3.4%; P = 0.24); and recurrent VTE, bleeding, or death (20.0% and 14.5%; P = 0.38). Daily mean cost per patient was US$12.63 ± $4.01 for UFH and US$9.87 ± $2.44 for enoxaparin (P < 0.001). The total costs considering the mean time of use were US$88.39 and US$69.11. Conclusion The treatment of VTE with enoxaparin provided cost savings in a large teaching hospital located in southern Brazil.

Deep venous thrombosis (DVT) in the lower extremities is the most frequent manifestation of venous thromboembolism (VTE), with an incidence of 0.48 to 1.6 cases/1000 persons-year among community residents [1], [2] and [3]. It is a common condition affecting mainly inpatients and rates increase with age. The most life-threatening manifestation is pulmonary embolism (PE), affecting 0.23 to 0.69 cases/1000 person-years [4]. The treatment of VTE recommended by the American College of Chest Physicians [5] involves short-term low-molecular-weight-heparin (LMWH) or unfractionated heparin (UFH) therapy plus long-term oral warfarin therapy. Anticoagulant therapy with UFH followed by warfarin prevents thrombus extension, reduces the risk of recurrent thrombosis, and prevents death in patients with VTE [6] and [7]. Subcutaneous LMWH is as effective and safe as conventional UFH therapy, but does not require laboratory monitoring and is less likely to cause bleeding, immune thrombocytopenia, and osteoporosis [8], [9] and [10]. LMWH preparartions differ considerably in composition, which could result in different antithrombotic effects, but there is no evidence that any LMWH preparation is better or worse than another in terms of efficacy or safety outcomes [11]. Enoxaparin is among the most widely studied treatments for VTE [12] and [13]. Despite LMWH having a greater acquisition cost, previous pharmacoeconomic analyses have shown that LMWH is more cost-effective than UFH [14], [15] and [16]. It has been calculated that outpatient treatment with LMWH may save $1641 per patient in comparison to UFH hospital treatment [17]. This economic benefit of outpatient treatment of VTE seems to be present in different health systems of developed countries, although the same can not be extrapolated to developing nations. Economic evaluations in developing countries are desirable to estimate VTE hospital treatment cost with UFH and LMWH, because people with low income do not have access to outpatient treatment with LMWH. We conducted a cohort study to evaluate the direct costs of short-term heparin anticoagulation treatment for VTE in a large teaching hospital located in southern Brazil, from the institutional perspective.

Treatment of VTE with enoxaparin provided costs savings in a large teaching hospital located in southern Brazil, from the institutional perspective. Despite differences in the settings where studies of economic evaluation were conducted, the findings agree in regard to the economic advantages of use of LMWH. Implementation of a critical pathway for anticoagulation is desirable to promote rational use of heparins and to save costs.