Economic evaluation of low-molecularweight heparin in the management of patients with unstable coronary artery disease
Objective. To undertake an economic evaluation of the administration and monitoring costs of the two different forms of heparin in patients with unstable coronary artery disease (DCAD).
Study design. Equivalent efficacy was found for lowmolecular- weight heparin (LMWH) and for unfractionated heparin (UFH) in the treatment of patients with UCAD. Cost minimisation analysis was carried out according to current local clinical practice in both the public sector and the private sector hospitals. Cost identification was carried out using local cost information, collected separately in both settings, and included costs for wastage and re-siting of drips.
Perspective. For the public sector perspective was that of the health care provider and for the private sector that of the third-party payer.
Results. Public sector costs for 48 hours and 72 hours of UFH therapy were R330.2I and R471.06, respectivel)'. In contrast costs of 4, 5 and 6 days of LMWH were R211.70, R252.28 and R294.94, respectively. Pharmaco-economics Unit, Department of Pharmacy, University of the Witwatersrand, Johannesburg Savings for 5 days of LMWH therapy versus 48 hours and 72 hours of UFH therapy were R77.41 and R77.93 per patient, respectively. Private sector costs for 48 hours and 72 hours of UFH therapy were R761.I4 and R1 02258, respectively. In contrast costs of 4, 5 and 6 days of LMWH were R462.26, R545.86 and R629.46, respectively. Savings for 5 days of LMWH therapy versus 48 hours and 72 hours of UFH therapy were R215.28 and R476.72 per patient, respectively. Sensitivity analysis showed LMWH to be the most cost-efficient form of intervention.
Conclusion. The results were robust in both settings, showing that LMWH is the most cost-effective form of heparin therapy in this patient group.