Key result
Outpatient DVT care with LMWH is linked to ~91% lower direct hospital costs vs. inpatient heparin.
Why the study?
The cost difference between contemporary outpatient and historical inpatient management of proximal lower limb DVT in adults was not well established.
Does outpatient management with low-molecular-weight heparin reduce direct hospital costs compared to inpatient management with unfractionated heparin in adults with proximal lower limb deep vein thrombosis?
Observational (n=100)
No
Does outpatient management with low-molecular-weight heparin reduce direct hospital costs compared to inpatient management with unfractionated heparin in adults with proximal lower limb deep vein thrombosis?
Shifting from inpatient unfractionated heparin to outpatient low-molecular-weight heparin for proximal DVT management results in substantial hospital cost savings.
Outpatient LMWH for proximal DVT was associated with lower costs versus historical inpatient UFH; extends observational data but requires RCT confirmation.
Study Objective. To compare the cost of contemporary outpatient and historical inpatient management of proximal lower limb deep vein thrombosis (DVT) in adults. Design. Prospective, observational study with historical inpatient cases as controls. Setting. Ambulatory thrombosis clinic of a tertiary care teaching center in Canada. Patients. Forty‐nine inpatients with DVT from a previous study in 1996 at the same institution who would have been eligible for outpatient therapy if this option had been available, and 51 consecutive patients referred to the ambulatory thrombosis clinic for treatment of DVT between March 2000 and January 2001. Intervention. The 49 inpatients received unfractionated heparin, and the 51 outpatients received low‐molecular‐weight heparin (LMWH). Measurements and Main Results. A cost‐minimization analysis restricted to the hospital perspective was conducted. This design was justified based on the clinical equivalence of the two treatment strategies. All direct hospital costs for treating the 51 consecutive outpatients with LMWH were measured. These data were compared with the cost of treating the inpatients with unfractionated heparin. The analysis horizon was limited to 7 days, based on the duration of hospitalization and length of heparin therapy for DVT before conversion to oral warfarin. The mean cost (in Canadian dollars) per outpatient case was $248 (95% confidence interval $216–280) and was significantly different from the mean cost/inpatient case of $2826 (adjusted for the difference in fiscal years) (p<0.0005). A breakdown of the outpatient cost showed that nursing time contributed to 51% of the cost, monitoring laboratory tests 5%, drugs 2%, and other costs (diagnostic laboratory tests and medical imaging) 42%. Conclusion. Converting from inpatient to outpatient treatment of proximal DVT was associated with a significant cost savings for our institution. Accordingly, it is financially advantageous for hospitals to offer this service as it reduces direct costs and does not appear to compromise patient care.
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Boucher et al. (2003) conducted an observational in Proximal lower limb deep vein thrombosis (DVT) (n=100). Outpatient management with low-molecular-weight heparin (LMWH) vs. Inpatient management with unfractionated heparin was evaluated on Mean direct hospital cost per case (in Canadian dollars) (p=<0.0005). Outpatient management of DVT with LMWH significantly reduced direct hospital costs compared with historical inpatient unfractionated heparin ($248 vs $2826 per case; p<0.0005).
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