Treatment of proximal vein thrombosis with subcutaneous low-molecular-weight heparin vs intravenous heparin. An economic perspective.
Treatment of proximal vein thrombosis with subcutaneous low-molecular-weight heparin vs intravenous heparin. An economic perspective.
复制标题
皮下低分子肝素与静脉注射肝素治疗近端静脉血栓。
DOI：
10.1001/archinte.157.3.289
复制
发表时间：
1997
影响因子：
--
通讯作者：
J. Feinglass
中科院分区：
文献类型：
--
作者：
R. D. Hull;G. E. Raskob;D. Rosenbloom;G. Pineo;R. G. Lerner;A. Gafni;A. Trowbridge;C. Elliott;D. Green;J. Feinglass
背景
皮下注射低分子肝素治疗近端静脉血栓至少与经典静脉注射肝素疗法一样有效和安全。低分子量肝素不需要进行抗凝监测。
目标
通过比较成本和有效性对这些治疗方法进行经济评估。
患者和方法
一项对 432 名近端静脉血栓形成患者进行的随机试验，将静脉注射肝素和低分子量肝素与临床结果的客观记录进行比较，为进行成本效益分析提供了机会，以根据成本和有效性对这些替代疗法进行排名。该分析的经济观点是第三方付款人（即加拿大卫生部或美国保险公司）的经济观点。
结果
在静脉肝素治疗组中，100 名患者的费用为 414,655 美元（加拿大元）或 375,836 美元（美元），客观记录的静脉血栓栓塞发生率为 6.9%。在低分子肝素治疗组中，100名患者的费用为399,403美元（加元）或335,687美元（美元），客观记录的静脉血栓栓塞发生率为2.8%，从而节省了15,252美元（加元）或40,149美元（美元）的费用。进行了多重敏感性分析，这些程序并没有改变研究结果。
结论
研究结果表明，低分子量肝素治疗至少与静脉注射肝素治疗一样有效和安全，但成本较低。高达 37% 接受低分子量肝素的患者有可能接受门诊治疗，这将大大节省成本。
BACKGROUND
Subcutaneous low-molecular-weight heparin is at least as effective and safe as classic intravenous heparin therapy for the treatment of proximal vein thrombosis. Anticoagulant monitoring is not required with low-molecular-weight heparin.
OBJECTIVE
To perform an economic evaluation of these therapeutic approaches by comparing cost and effectiveness.
PATIENTS AND METHODS
A randomized trial in 432 patients with proximal vein thrombosis that compared intravenous heparin and low-molecular-weight heparin with objective documentation of clinical outcomes provided the opportunity to perform an analysis of cost-effectiveness to rank these alternative therapies in terms of both their cost and effectiveness. The economic viewpoint of this analysis was that of a third-party payer (ie, a ministry of health in Canada or an insurance company in the United States).
RESULTS
In the intravenous heparin-treated group, the cost incurred for 100 patients was $414,655 (Canadian dollars) or $375,836 (US dollars), with a frequency of objectively documented venous thromboembolism of 6.9%. In the low-molecular-weight heparin-treated group, the cost incurred for 100 patients was $399,403 (Canadian dollars) or $335,687 (US dollars), with a frequency of objectively documented venous thromboembolism of 2.8%, thus providing a cost saving of $15,252 (Canadian dollars) or $40,149 (US dollars). Multiple sensitivity analyses were performed, and these procedures did not alter the findings of the study.
CONCLUSIONS
The findings indicate that low-molecular-weight heparin therapy is at least as effective and safe but less costly than intravenous heparin treatment. The potential for outpatient therapy in up to 37% of patients who are receiving low-molecular-weight heparin would substantially augment the cost saving.