Economic issues in the treatment and prevention of deep vein thrombosis from a managed care perspective.

Treatment and prevention of deep vein thrombosis (DVT) raise a number of important economic issues. Economic burden of the disease is a primary concern. Enrollment trends indicate that the patient population mix in managed care health plans is changing. Health plans are enrolling a growing number of members who are at higher risk for DVT. Accordingly, managed care health plans will increasingly need to focus attention on the development of high-quality and cost-effective strategies for treatment and prevention of DVT. It is widely agreed that the use of low-molecular-weight heparin (LMWH) is safe and effective, and there is also good evidence that its use is cost effective in selected indications. The shift from inpatient to outpatient treatment that is made possible by substitution of LMWH for conventional unfractionated heparin brings with it a need to restructure healthcare delivery resources. This may have substantial economic impact on both providers and health plan members. Growing recognition of the DVT risk associated with various disease states, as well as the costly long-term sequelae of DVT, is spurring a trend to broader use of LMWH for prophylaxis. The relative cost effectiveness of prevention depends on the tradeoff between an expenditure that is made today and an uncertain future benefit. What is needed now is better evidence as a basis for decisions regarding DVT prophylaxis and clinical studies that track the long-term clinical and economic impact of DVT.