Management of acute proximal deep vein thrombosis: Pharmacoeconomic evaluation of outpatient treatment with enoxaparin vs inpatient treatment with unfractionated heparin

Alex C. Spyropoulos, Judith S. Hurley, Gabrielle N. Ciesla, Gregory De Lissovoy

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives: A landmark Canadian randomized controlled clinical trial compared treatment of acute proximal vein thrombosis via low-molecular-weight heparin (LMWH) [enoxaparin] administered primarily at home with IV unfractionated heparin (UH) in the hospital. Results demonstrated equivalent safety and efficacy for home care with enoxaparin with a reduction in cost. Our objective was to validate these findings in the routine practice setting of a US health maintenance organization. Design: Retrospective analysis of medical and administrative records of health-plan members meeting inclusion-exclusion criteria of the Canadian trial during the period from 1995 to 1998. Setting: Staff-model health maintenance organization serving New Mexico. Patients: Persons presenting as outpatients from 1995 to 1996 or from 1997 to 1998 with acute, proximal deep vein thrombosis (DVT) diagnosed by duplex ultrasonography. Interventions: Initial anticoagulant therapy of IV UH administered in the hospital (from 1995 to 1996 group, n = 64) or subcutaneous LMWH (enoxaparin) administered primarily at home (from 1997 to 1998 group, n = 65), followed by warfarin therapy. Results: No statistically significant differences were observed in the number of recurrent venous thromboembolic events (p = 0.36) or bleeding events (p = 1.0). Mean ± SD cost per patient was $9,347 ± 8,469 in the enoxaparin group compared with $11,930 ± 10,892 in the UH group, a difference of -$2,583 (95% bootstrap-adjusted asymmetrical confidence interval, -$6,147, + $650). Conclusions: Retrospective replication of the Canadian study in a US routine (managed) care setting found similar clinical and economic outcomes. Treatment of acute proximal DVT with enoxaparin in a primarily outpatient setting can be accomplished safely and yields savings through avoidance or minimization of inpatient stays.

Original languageEnglish (US)
Pages (from-to)108-114
Number of pages7
JournalChest
Volume122
Issue number1
DOIs
StatePublished - 2002
Externally publishedYes

Keywords

  • Economics
  • Enoxaparin
  • Low-molecular-weight heparin
  • Managed care
  • Outpatient treatment
  • Pharmacoeconomic evaluation
  • Proximal deep vein thrombosis
  • Utilization

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

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