AIM: To estimate the costs and benefits for a UK hospital pharmacy of stocking a single low molecular weight heparin (LMWH), enoxaparin, compared to stocking unfractionated heparin (UFH) and stocking both UFH and multiple different LMWHs. METHODS: A decision-tree model was developed which considered the use of heparins for five indications: prophylaxis against venous thromboembolism (VTE) in major orthopaedic surgery; VTE prophylaxis in major general surgery; VTE prophylaxis in acute medical inpatients; treatment of diagnosed VTE; and anticoagulation for patients with unstable angina and non-ST-elevation myocardial infarction (UA/NSTEMI). Previously published cost-effectiveness analyses for each indication were combined into a single model and updated to 2002 prices. The number of patients given heparin in each indication was estimated from the pharmacy records of a large UK teaching hospital. The model estimated the use of drugs, staff time, clinical events and resource use resulting from anti-coagulation. Costs were estimated from the perspective of the hospital and the UK National Health Service. RESULTS: Total annual cost was estimated to be pounds sterling 3.2 m (single LMWH), pounds sterling 4.4 m (UFH only) and pounds sterling 3.7 m (multiple heparins). The largest expected cost savings from using a single LMWH compared to UFH only resulted from reduced hospital stay for DVT treatment, reduced revascularisation in UA/NSTEMI and fewer VTE events in orthopaedic surgery. Expected cost savings from using a single LMWH compared to multiple heparins were more modest CONCLUSION: Sub-optimal choice of anticoagulants may result in substantial excess costs elsewhere in the hospital.
AIM: To estimate the costs and benefits for a UK hospital pharmacy of stocking a single low molecular weight heparin (LMWH), enoxaparin, compared to stocking unfractionated heparin (UFH) and stocking both UFH and multiple different LMWHs. METHODS: A decision-tree model was developed which considered the use of heparins for five indications: prophylaxis against venous thromboembolism (VTE) in major orthopaedic surgery; VTE prophylaxis in major general surgery; VTE prophylaxis in acute medical inpatients; treatment of diagnosed VTE; and anticoagulation for patients with unstable angina and non-ST-elevation myocardial infarction (UA/NSTEMI). Previously published cost-effectiveness analyses for each indication were combined into a single model and updated to 2002 prices. The number of patients given heparin in each indication was estimated from the pharmacy records of a large UK teaching hospital. The model estimated the use of drugs, staff time, clinical events and resource use resulting from anti-coagulation. Costs were estimated from the perspective of the hospital and the UK National Health Service. RESULTS: Total annual cost was estimated to be pounds sterling 3.2 m (single LMWH), pounds sterling 4.4 m (UFH only) and pounds sterling 3.7 m (multiple heparins). The largest expected cost savings from using a single LMWH compared to UFH only resulted from reduced hospital stay for DVT treatment, reduced revascularisation in UA/NSTEMI and fewer VTE events in orthopaedic surgery. Expected cost savings from using a single LMWH compared to multiple heparins were more modest CONCLUSION: Sub-optimal choice of anticoagulants may result in substantial excess costs elsewhere in the hospital.
Authors: P Mismetti; S Laporte-Simitsidis; B Tardy; M Cucherat; A Buchmüller; D Juillard-Delsart; H Decousus Journal: Thromb Haemost Date: 2000-01 Impact factor: 5.249
Authors: M M Samama; A T Cohen; J Y Darmon; L Desjardins; A Eldor; C Janbon; A Leizorovicz; H Nguyen; C G Olsson; A G Turpie; N Weisslinger Journal: N Engl J Med Date: 1999-09-09 Impact factor: 91.245
Authors: A Planes; N Vochelle; F Mazas; C Mansat; J Zucman; A Landais; J C Pascariello; D Weill; J Butel Journal: Thromb Haemost Date: 1988-12-22 Impact factor: 5.249
Authors: Dalia M Dawoud; David Wonderling; Jessica Glen; Sedina Lewis; Xavier L Griffin; Beverley J Hunt; Gerard Stansby; Michael Reed; Nigel Rossiter; Jagjot Kaur Chahal; Carlos Sharpin; Peter Barry Journal: Front Pharmacol Date: 2018-11-27 Impact factor: 5.810