Breaking out of the silo: one health system's experience.

Abstract

Pharmacoeconomic evidence for inpatient deep vein thrombosis (DVT) treatment with low-molecular-weight heparins (LMWHs) and one health system's experience with this treatment compared with unfractionated heparins (UFHs) are examined. Applying clinical and pharmacoeconomic evidence to clinical practice can be challenging, especially when using high-cost therapies, because of the limited financial resources of health systems. While LMWHs have higher acquisition costs, they offer several advantages over UFHs, contributing to their overall pharmacoeconomic value. Inpatient treatment of DVT with LMWHs has not been widely adopted, despite the clinical evidence supporting their use, partly because of the up-front cost of these medications. A cost-minimization analysis was performed to estimate the cost impact of switching from UFHs to LMWHs for inpatient treatment of DVT at the Detroit Medical Center (DMC). The costs of once- and twice-daily administration of enoxaparin were compared with those of UFH. The costs of medications, laboratory tests, and pharmacist time were calculated. Costs for hospital stay and medical fees were assumed to be similar among all treatment groups. The annual cost for DVT treatment for the entire DMC was then estimated using pharmacoeconomic modeling and Monte Carlo simulation. Inpatient UFH costs totaled $138,580, once-daily LMWHs were $177,531, and twice-daily LMWHs cost $205,569 for 500 patients with primary DVT. Treatment with LMWHs cost $20-$34 more per patient per day than UFHs, but incurred savings by reducing readmission and reocclusion rates. LMWHs are a cost-effective treatment for DVT, from both a third-party-payer and a societal perspective.