Cost Implications of Using Unfractionated Heparin or Enoxaparin in Medical Patients at Risk for Venous Thromboembolic Events

ABSTRACT Background. Previous economic studies have compared the cost effectiveness of different heparins used as prophylaxis against venous thromboembolism (VTE) in medical patients at risk. These pharmacoeconomic evaluations have revealed cost benefits of enoxaparin over unfractionated heparin (UFH). However, these modeling studies generally do not use “real-life” hospital data to calculate the actual cost difference from a hospital perspective. Objective. We sought to compare the total cost of care, from a hospital perspective, of thromboprophylaxis with UFH and enoxaparin in patients at risk. Research Design and Methods. Using modified, All-Payer, Severity-Adjusted Diagnosis-Related Groups (M-APS-DRGs), we performed a retrospective analysis of administrative data from 89,584 at-risk patients in 15 U.S. hospitals. Patients were considered for this study if they were in nonsurgical M-APSDRGs in which at least 50% of patients stayed in the hospital for five or more days. Patients receiving UFH and enoxaparin were identified and compared, within the same M-APS-DRGs, based on the total cost of care associated with the various therapies. We also calculated costs at the cost-center level in order to elucidate where the use of inpatient hospital resources differed. Results. Forty-seven M-APS-DRGs (with 10,953 discharged patients receiving UFH and 6,246 receiving enoxaparin) had used both drugs sufficiently for inclusion in the study. Lower costs were observed with enoxaparin than with UFH in 35 M-APS-DRGs (74%). Differences were statistically significant in 17 M-APS-DRGs (36.2%); 15 of those showed lower costs with enoxaparin. The severity-adjusted mean saving per discharge with enoxaparin was $1,002. Overall, length of hospital stay was 0.6 days greater with enoxaparin than with UFH. Conclusion. Enoxaparin was associated with lower total inpatient costs of care than UFH for preventing VTE in hospitalized at-risk patients.