Economic Evaluation of Unfractionated Heparin Versus Low-Molecular-Weight Heparin to Prevent Venous Thromboembolism in General Medical and Non-Orthopedic Surgical Patients [Internet]

Deep vein thrombosis (DVT) and pulmonary embolism (PE) constitute venous thromboembolism (VTE), which is common in hospitalized patients and is a major source of morbidity and mortality in both medical and non-orthopedic surgery patients. VTE is one of the most common preventable causes of in-patient mortality; among more than seven million patients discharged from 944 North American acute care hospitals, post-operative VTE was the second most common medical complication, the second most common cause of excess length of stay, and the third most common cause of excess mortality and costs. As such, strategies to reduce the occurrence of VTEs are critical in at-risk patients, and prophylactic administration of heparin has emerged as a standard of care.The two most common options are unfractionated heparin (UFH) and low-molecular-weight heparin (LMWH). While some studies have concluded that the efficacy and safety of UFH and LMWH are similar, others have suggested there may be differences in their clinical effectiveness and safety, including risks of bleeding and heparin-induced thrombocytopenia (HIT). From a health care resource-utilization perspective, in the past, the drug acquisition costs of UFH have typically been substantially lower than LMWH. However, due to price reductions in LMWH and the recent increases in the cost of UFH resulting from higher manufacturing costs to ensure safety, the difference in drug costs is decreasing. Given the widespread use of heparin-based VTE prophylaxis, even small differences in outcomes and costs may have significant clinical and economic implications.Given these considerations, the selection of a VTE prevention pharmacologic option is an important decision, both from a hospital formulary and a clinical perspective. In order to inform decision-making within provincial and territorial regional health authorities (RHAs) and hospitals, a health technology assessment (HTA) of anticoagulants for the prevention of VTE in the hospital setting was undertaken. This HTA project was a collaboration between the Drug Safety and Effectiveness Network (DSEN) of the Canadian Institute of Health Research and CADTH. A research group affiliated with DSEN (the University of Ottawa Heart Institute Cardiovascular Research Methods Centre [UOHI-CRMC]) conducted a systematic review comparing the clinical efficacy and safety of UFH and LMWH in preventing VTE in hospitalized medical and surgical (non-orthopedic/general abdominal surgery) patients. CADTH conducted an economic evaluation to determine the cost-effectiveness of LMWH versus UFH for the prevention of VTE in the same populations. This report provides results from the economic evaluation; results from the clinical review are available in a separate report.

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