Comparison of the cost-effectiveness of administering heparin subcutaneously or intravenously for the treatment of deep vein thrombosis.

The cost-effectiveness of subcutaneous heparin (20,000 iu, twice daily, prefilled syringes), a continuous intravenous infusion of 24,000 iu heparin in 24 h, and the intravenous infusion of 48,000 iu heparin as two consecutive 12-h infusions of 24,000 iu, were compared. The costs were calculated by timing and observing staff in three hospitals, and by noting the costs of what they used. Cannulation of a vein by a doctor took a mean of 4 min 16 s and cost 2.61 pounds. To prepare and administer the 24,000 iu of heparin in a 24-h infusion took a mean of 22 min 42 s/day and cost 9.52 pounds. If a 48,000 iu in 24-h infusion was used it took a mean of 36 min 3 s/day and cost 16.81 pounds. The use of heparin syringes, 20,000 iu subcutaneously twice daily, took 2 min 53 s/day and cost 4.80 pounds. A generic cost formula was calculated to allow for variation in staff or drug costs. The subcutaneous and intravenous routes were assumed to be equally effective on the basis of the medical literature. This study shows that subcutaneous heparin therapy is significantly more cost-effective than intravenous heparin therapy. The reduction in cost and liberation of nursing time mean that the subcutaneous route should be preferred.