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In critically ill patients, dalteparin is more cost-effective for VTE prevention

Key clinical point: Dalteparin is more cost-effective than unfractionated heparin in the prevention of venous thromboembolism.

Major finding: Dalteparin is as effective as unfractionated heparin in reducing thrombosis, for the same cost, but with less pulmonary embolus and heparin-induced thrombocytopenia.

Data source: Economic analysis of a prospective randomized controlled trial of low molecular weight heparin dalteparin versus unfractionated heparin in 2344 critically-ill medical-surgical patients

Disclosures: The E-PROTECT study was funded by the Heart and Stroke Foundation (Ontario, Canada), the University of Toronto, and the Canadian Intensive Care Foundation. PROTECT was funded by the Canadian Institutes of Health Research, the Heart and Stroke Foundation (Canada), and the Australian and New Zealand College of Anesthetists Research Foundation. Some authors reported fees, support, and consultancies to the pharmaceutical industry.


 

FROM JAMA

References

The low molecular weight heparin dalteparin and unfractionated heparin are associated with similar rates of thrombosis and major bleeding, but dalteparin is associated with lower rates of pulmonary embolus and heparin-induced thrombocytopenia, based on results from a prospective randomized study.

Given for prevention of venous thromboembolism, median hospital costs per patient were $39,508 for dalteparin users and $40,805 for unfractionated heparin users. Dalteparin remained the least costly strategy until its acquisition costs rose from $8 per dose to $179, as reported online 1 November in the Journal of the American Medical Association [doi:10.1001/jama.2014.15101].

Dalteparin is more cost-effective than unfractionated heparin in the prevention of venous thromboembolism. CDC/Janice Carr

Dalteparin is more cost-effective than unfractionated heparin in the prevention of venous thromboembolism.

The economic analysis—conducted alongside the multi-centre, randomized PROTECT trial in 2344 critically-ill medical-surgical patients— showed no matter how low the acquisition cost of unfractionated heparin, there was no threshold that favored that form of prophylaxis, according to data also presented at the Critical Care Canada Forum.

“From a health care payer perspective, VTE prophylaxis with the LMWH [low molecular weight heparin] dalteparin in critically ill medical-surgical patients was more effective and had similar or lower costs than the use of UFH [unfractionated heparin],” wrote Dr. Robert A. Fowler, from the Sunnybrook Health Sciences Centre, University of Toronto, and colleagues.The E-PROTECT study was funded by the Heart and Stroke Foundation (Ontario, Canada), the University of Toronto, and the Canadian Intensive Care Foundation. PROTECT was funded by the Canadian Institutes of Health Research, the Heart and Stroke Foundation (Canada), and the Australian and New Zealand College of Anesthetists Research Foundation. Some authors reported fees, support, and consultancies from the pharmaceutical industry.

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