Cost effectiveness of bemiparin sodium versus unfractionated heparin and oral anticoagulants in the acute and long-term treatment of deep vein thrombosis

Introduction: Low-molecular-weight heparins (LMWHs) are at least as effective and well tolerated as unfractionated heparin (UFH) in the treatment of deep vein thrombosis (DVT), offering easier administration and obviating the need for anticoagulant monitoring, but have a higher acquisition cost than UFH. Objective: To quantify the potential economic impact of two regimens of subcutaneous bemiparin 115 IU/kg/day for 7-10 days (plus oral anticoagulants [OAC] or followed by long-term bemiparin 3500IU) versus dose-adjusted intravenous UFH for 7 days plus OAC for 3 months in the acute and long-term treatment of DVT. The representative patient was a 62-year-old, 77kg male with proximal DVT of the lower limbs. Methods: A cost-effectiveness analysis was performed using a decision-tree modelling approach. The results were expressed in terms of costs (E, 2002 values) and incremental cost effectiveness. The treatment costs (hospital stay, physician services, drug administration) and costs incurred due to complications (pulmonary embolism, recurrent DVT, bleeding events, thrombocytopenia and deaths) during the 3-month study period were considered for the primary analysis. Life expectancy and QALYs were considered for the secondary analysis. The study was performed in the setting of the Spanish National Health System. Results: Bemiparin plus OAC or long-term bemiparin for 3 months provided net cost savings of E769 and E908 per patient, respectively, compared with UFH plus OAC (UFH plus OAC E4128 vs bemiparin plus OAC E3359 vs long-term bemiparin E3220). Bemiparin plus DAC and long-term bemiparin for 3 months were calculated to avoid 27 and 7 additional WE events, respectively, per 1000 patients treated. Bemiparin plus DAC or long-term bemiparin increased quality-adjusted life expectancy by approximately 1.72 and 0.74 years, respectively, compared with UFH plus OAC. The univariate sensitivity analysis supported the cost effectiveness of bemiparin in all the ranges tested for complications and costs. Conclusions: Our model suggests that bemiparin plus OAC or long-term bemiparin for 3 months may be dominant strategies over UFH plus OAC in the treatment of DVT from the Spanish National Health System perspective, offering better outcomes and cost savings. Long-term bemiparin may be a cost-neutral alternative to bemiparin plus OAC.