Purpose: The results of studies of the comparative efficacy, safety, feasibility, and costs of using low molecular weight heparin (LMWH) or unfractionated heparin (UFH) for the treatment of venous thromboembolism (VTE) are reviewed. Cost-effectiveness research comparing LMWH with warfarin or UFH and comparing the activated factor X inhibitor fondaparinux with LMWH for VTE prophylaxis also is discussed.
Summary: The greater ease of administration, fewer laboratory monitoring requirements, and feasibility of using LMWH safely on an outpatient basis instead of on an inpatient basis facilitate earlier hospital discharge and make LMWH more cost-effective than UFH for the treatment of DVT. The use of LMWH instead of warfarin to prevent VTE increases costs, but it is more effective for preventing DVT and death at a relatively small incremental cost per DVT event avoided and cost per death averted. The total expected costs are higher, but the expected cost per DVT event avoided is lower when enoxaparin is used instead of UFH for VTE prophylaxis.
Conclusion: Fondaparinux is more cost-effective than enoxaparin for VTE prophylaxis, with a cost saving that increases progressively over time.