0
Clinical Investigations: CARDIOLOGY |

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

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

*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@swissonline.ch



Chest. 2005;128(3):1601-1610. doi:10.1378/chest.128.3.1601
Text Size: A A A
Published online

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.

Figures in this Article

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

CHEST Journal Articles
PubMed Articles
Guidelines
Guidelines on the use and monitoring of heparin.
British Committee for Standards in Haematology | 9/25/2009
Venous thromboembolism (VTE).
University of Michigan Health System | 7/31/2009
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543