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(Chest. 2005;128:1601-1610.)
© 2005 American College of Chest Physicians

Cost-Effectiveness of Low-Molecular-Weight Heparin for Treatment of Pulmonary Embolism*

Drahomir Aujesky, MD, MSc; Kenneth J. Smith, MD; Jacques Cornuz, MD, MPH and Mark S. Roberts, MD, MPP

* From the Division of General Internal Medicine (Drs. Aujesky, Smith, and Roberts), Department of Medicine, University of Pittsburgh, Pittsburgh, PA; and the University Outpatient Clinic (Dr. Cornuz), University of Lausanne, Lausanne, Switzerland.

Correspondence to: Drahomir Aujesky, MD, MSc, Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, University Drive C, Building 28, Suite 1A129, Pittsburgh, PA 15240; e-mail: aujesky{at}swissonline.ch

Background: Low-molecular-weight heparin (LMWH) appears to be safe and effective for treating pulmonary embolism (PE), but its cost-effectiveness has not been assessed.

Methods: We built a Markov state-transition model to evaluate the medical and economic outcomes of a 6-day course with fixed-dose LMWH or adjusted-dose unfractionated heparin (UFH) in a hypothetical cohort of 60-year-old patients with acute submassive PE. Probabilities for clinical outcomes were obtained from a metaanalysis of clinical trials. Cost estimates were derived from Medicare reimbursement data and other sources. The base-case analysis used an inpatient setting, whereas secondary analyses examined early discharge and outpatient treatment with LMWH. Using a societal perspective, strategies were compared based on lifetime costs, quality-adjusted life-years (QALYs), and the incremental cost-effectiveness ratio.

Results: Inpatient treatment costs were higher for LMWH treatment than for UFH ($13,001 vs $12,780), but LMWH yielded a greater number of QALYs than did UFH (7.677 QALYs vs 7.493 QALYs). The incremental costs of $221 and the corresponding incremental effectiveness of 0.184 QALYs resulted in an incremental cost-effectiveness ratio of $1,209/QALY. Our results were highly robust in sensitivity analyses. LMWH became cost-saving if the daily pharmacy costs for LMWH were <$51, if ≥ 8% of patients were eligible for early discharge, or if ≥ 5% of patients could be treated entirely as outpatients.

Conclusion: For inpatient treatment of PE, the use of LMWH is cost-effective compared to UFH. Early discharge or outpatient treatment in suitable patients with PE would lead to substantial cost savings.

Key Words: cost-effectiveness • low-molecular-weight heparin • pulmonary embolism




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