Hospitalized medical patients with defined VTE risk factors are at high risk of venous thromboembolism (VTE) in the absence of VTE prophylaxis. As national quality initiatives are implemented in the United States to improve current suboptimal VTE prophylaxis practices, it is important for both hospitals and payers to appraise the relative costs of each option. We therefore compared the 2‐year costs of no VTE prophylaxis, unfractionated heparin (UFH) prophylaxis, and enoxaparin prophylaxis in at‐risk medical patients.
A Markov chain model with resampling, covering VTE‐related costs up to 2 years postdischarge, was developed. The total costs over 2 years in 3 groups (UFH prophylaxis, enoxaparin prophylaxis, and no prophylaxis) were compared, with each group comprising a hypothetical cohort of 10,000 medically ill patients at risk for VTE (according to the MEDENOX study criteria). Economic inputs, derived from published robust clinical trials and registries, were drug acquisition costs, index and recurrent VTE treatment costs (including hospitalization costs), adverse event costs (minor/major bleeds and heparin‐induced thrombocytopenia), and complication‐treatment costs (post‐thrombotic syndrome and pulmonary hypertension). Sensitivity and threshold analyses were performed to test the general applicability of the model.
The mean 2‐year total cost per patient was lowest with enoxaparin, at $1264, compared with $1585 for UFH and $2245 for no prophylaxis. Day 1‐30 costs were $877 for enoxaparin, $1135 for UFH, and $1224 for no prophylaxis. Approximately 70% of all costs occurred during the first 30 days for both enoxaparin and UFH prophylaxis. The largest cost component for all cohorts was the treatment of primary VTE, at $611, $700, and $1527 for enoxaparin prophylaxis, UFH prophylaxis, and no prophylaxis, respectively.
Based on inputs from robust clinical trials, enoxaparin prophylaxis in at‐risk medical patients appears to be associated with lower cost over 2 years than UFH prophylaxis or no prophylaxis.
Financial and editorial support for this publication was provided by sanofi‐aventis US, Inc.
S. Deitelzweig, Ochsner Hospital, Research grant/honoraria: sanofi‐aventis, BMS, Scios; J. Lin, sanofi‐aventis, employee at sanofi‐aventis; J. Benner, IMS Health, Sanofi‐aventis funded this research by IMS Health; R. Becker, IMS Health, Sanofi‐aventis funded this research by IMS Health.
To cite this abstract:Deitelzweig S, Lin J, Benner J, Becker R. Two‐Year Costs of Enoxaparin Prophylaxis, Unfractionated Heparin Prophylaxis, or No Prophylaxis in Medical Patients at Risk of Venous Thromboembolism. Abstract published at Hospital Medicine 2008, April 3-5, San Diego, Calif. Abstract 17. Journal of Hospital Medicine. 2008; 3 (suppl 1). https://www.shmabstracts.com/abstract/twoyear-costs-of-enoxaparin-prophylaxis-unfractionated-heparin-prophylaxis-or-no-prophylaxis-in-medical-patients-at-risk-of-venous-thromboembolism/. Accessed November 13, 2019.