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A recent economic study by the University of Calgary in Alberta, Canada, evaluated the cost and effectiveness of traditional heparin as opposed to its low molecular weight version (LMWH).1 Savings for the LMWH group amounted to $40,149, further substantiating intuitive suggestions of the agent’s cost-effectiveness.
Patients in the intravenous heparin-treated group received an initial bolus dose of 5,000 U. Those at high risk for bleeding then were continuously infused with heparin at a rate of 1,240 U/h. Those at low risk for bleeding were continuously infused with heparin at a rate of 1,680 U/h. The dose was adjusted according to the results of laboratory monitoring of activated partial thromboplastin time. Patients who received LMWH subcutaneously were given a fixed dose of 175 international factor Xa U/kg of body weight once every 24 hours.
Beginning on the second day of initial therapy, all patients received 10 mg warfarin, and the dose was adjusted daily in the intravenous group according to monitoring of prothrombin time. Warfarin therapy continued for at least three months in all patients. Aspirin was prohibited.
In the intravenous heparin-treated group, the cost incurred for 100 patients with proximal vein thrombosis was $375,836, with a frequency of venous thromboembolism of 6.9%. In the LMWH-treated group, the equivalent cost was $335,687 with a frequency of venous thromboembolism of 2.8%. Ten patients who received LMWH died, compared with 21 who received the intravenous preparation.
"In an era where the main battles in the health care sector are driven by cost considerations," say the study authors, "this observation will impact on the therapy for deep vein thrombosis."