The objective of this study was to compare the costs, from the perspective of the payer, of using nadroparin calcium, a low-molecular-weight heparin, instead of unfractionated heparin in the prophylaxis of venous thromboembolism in patients undergoing orthopaedic surgery or major general surgery in Italy.
The methods used were based on a published meta-analysis and a survey of clinical practice. We constructed a model of the prophylaxis and management of venous thromboembolism in Italy. Resource use associated with individual events was estimated on the basis of the clinical survey. Unit costs, not available from published sources, were taken from charges made by hospitals and from direct observation. A sensitivity analysis was conducted to examine whether the results were robust to changes in key variables.
In the base case, compared with unfractionated heparin, prophylaxis with nadroparin calcium reduced the expected costs of managing thromboembolism by 267 226 Italian lire (L, 1994 values; $US 1 = L1600 approx.) per patient undergoing orthopaedic surgery, and by L45 588 per patient undergoing major general surgery. Therefore, switching from unfractionated heparin to nadroparin calcium in these patients offers the possibility of significant cost savings to the Italian healthcare system.
Pulmonary Embolism Adis International Limited Deep Vein Thrombosis Venous Thromboembolism Unfractionated Heparin
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
This is a preview of subscription content, log in to check access.
Thromboembolic Risk Factors (THRIFT) Consensus Group. Risk of and prophylaxis for thromboembolism in hospital patients. BMJ 1992; 305: 567–74CrossRefGoogle Scholar
Prevention of venous thromboembolism: European consensus statement. Developed under the auspices of the Cardiovascular Disease Education and Research Trust; 1991 Nov 1-5; Windsor. Cyprus: Med-Orion Publishing Company, 1992Google Scholar
Wille-Jørgesen P. Prophylaxis of postoperative thromboembolism. Dan Med Bull 1991; 38: 203–28Google Scholar
Clagett GP, Reisch lS. Prevention of venous thromboembolism in general surgery patients. Ann Surg 1988; 208: 227–40PubMedCrossRefGoogle Scholar
Collins R, Scrimgeour A, Yusuf S, et al. Reduction in fatal pulmonary embolism and venous thrombosis by perioperative administration of subcutaneous heparin. N Engl J Med 1988; 318: 1162–73PubMedCrossRefGoogle Scholar
Drug Information Pharmacists, South West Thames, New Product Assessment. Low-molecular-weight heparins. London: Drug Information Pharmacists Group, 1991Google Scholar
Hommes OW, Bura A, Mazzolai L, et al. Subcutaneous heparin compared with continuous intravenous heparin administration in the initial treatment of deep vein thrombosis. Ann Intern Med 1992; 116: 279–84PubMedGoogle Scholar
Frydman AM, Bara L, Le Roux Y, et al. The antithrombotic activity and pharmacokinetics of enoxaparin, a low molecular weight heparin, in humans given single subcutaneous doses of 20 to 80 ml. J Clin Pharmacol 1988; 8: 609–18Google Scholar
Caen lP. A randomized double-blind study between a low molecular weight heparin Kabi 2165 and standard heparin in the prevention of deep vein thrombosis in general surgery. Thromb Haemost 1988; 59: 216–9PubMedGoogle Scholar
Deehavanne M, Ville D, Berruyer M, et al. Randomized trial of a low molecular weight heparin (Kabi 2165) versus adjusted dose subcutaneous standard heparin in the prophylaxis of deep vein thrombosis after elective hip surgery. Haemostasis 1989; 1: 5–12Google Scholar
Encke A, Breddin K. Comparison of a low molecular weight and unfractionated heparin for the prevention of deep vein thrombosis in patients undergoing abdominal surgery. Br J Surg 1988; 75: 1058–63CrossRefGoogle Scholar
Eriksson BI, Eriksson E, Wudenvik H, et al. Comparison of low molecular weight heparin and unfractionated heparin in prophylaxis of deep vein thrombosis and pulmonary embolism in total hip replacement [abstract]. Thromb Haemostas 1989; 62: 470Google Scholar
Fricker lP, Vergnes Y, Schach R, et al. Low dose heparin versus low molecular weight heparin (Kabi 2165, Fragmin) in the prophlyaxis of thromboembolic complications of abdominal oncological surgery. Eur J Clin Invest 1988; 18: 561–7PubMedCrossRefGoogle Scholar
Hartl P, Brticke P, Dienstl E, et al. Prophylaxis of thromboembolism in general surgery: comparison between standard heparin and Fragmin. Thromb Res 1990; 57: 577–84PubMedCrossRefGoogle Scholar
Kakkar VV, Murray W1G. Efficacy and safety oflow molecular weight heparin (CY216) in preventing postoperative thrombo-embolism: a cooperative study. Br J Surg 1985; 72: 786–91PubMedCrossRefGoogle Scholar
Leyvraz PF, Postel M, Bachmann F, et al. Prevention of deep vein thrombosis after total hip replacement: randomized comparison between adjusted dose unfractionated heparin and low molecular weight heparin (CY216). In: Hoeck lA, editor. Deep vein thrombosis following total hip replacement. Amsterdam: University of Amsterdam, 1990Google Scholar
Planes A, Vochelle N, Mazas F, et al. Prevention of postoperative venous thrombosis: a randomized trial comparing unfractionated heparin with low molecular weight heparin in patients undergoing total hip replacement. Thromb Haemostas 1988; 60: 407–11Google Scholar
Samama M, Bernard P, Bonnardot JP, et al. Low molecular weight heparin with unfractionated heparin in prevention of postoperative thrombosis. Br J Surg 1988; 75: 128–31PubMedCrossRefGoogle Scholar
Nurmohamed MT, Rosendaal FR, Büller HR, et al. Low molecular weight heparins versus standard heparins in general and orthopaedic surgery: a meta analysis. Lancet 1992; 340: 152–6PubMedCrossRefGoogle Scholar
Leizorovicz A, Haugh MC, Chopuis ER, et al. Low molecular weight heparin in prevention of perioperative thrombosis. BMJ 1992; 305 (6859): 913–20PubMedCrossRefGoogle Scholar
Drummond M, Aristides M, Davies L, et al. Economic evaluation of standard heparin and enoxaparin for prophylaxis against deep vein thrombosis in elective hip surgery. Br J Surg 1994; 81 (12): 1742–6PubMedCrossRefGoogle Scholar
Borris LC, Lassen MR, Jensen HP, et al. Perioperative thrombosis prophylaxis with low molecular weight heparins in elective hip surgery: clinical and economic considerations. Int J Clin Pharmacol Ther 1994; 32 (5): 262–8PubMedGoogle Scholar
Heaton D, Pearce M. Low molecular weight versus unfractionated heparin: a clinical and economic appraisal. Pharmacoeconomics 1995; 8 (2): 91–9PubMedCrossRefGoogle Scholar
Anderson DR, O’Brien BJ, Levine MN, et al. Efficacy and cost of low molecular weight heparin compared with standard heparin for the prevention of deep vein thrombosis after total hip arthroplasty. Ann Intern Med 1993; 119: 1105–12PubMedGoogle Scholar
Garattini L, Grilli R, Scopelliti D, et al. A proposal for Italian guidelines in pharmacoeconomics. Pharmacoeconomics 1995; 7 (1): 1–6PubMedCrossRefGoogle Scholar
Nyman U. Diagnostic strategies in acute pulmonary embolism. Haemostasis 1993; 23 Suppl.1: 220–6PubMedGoogle Scholar
Law Om n 80, 7 XI 1991, Gazzetta Ufficiale n 2876, Rome: Italian Government, 1991 Dec 6Google Scholar
Levine M, Gent M, Hirsch J, et al. A comparison of low-molecular weight heparin administered primarily at home with unfractionated heparin administered in hospital for proximal deep vein thrombosis. N Engl J Med 1996; 334 (11): 677–81PubMedCrossRefGoogle Scholar
Koopman MMW, Prandoni P, Piovella F, et al. Treatment of venous thrombosis with intravenous unfractionated heparin administered in the hospital as compared with subcutaneous low-molecular-weight heparin administered at home. N Engl J Med; 34 (11): 682–7Google Scholar