Does low-molecular-weight heparin reduce the costs of venous thromboembolism treatment?

The development of low-molecular-weight heparins (LMWHs) has revolutionized the dominant treatment strategy of established deep vein thrombosis and pulmonary embolism. In a further attempt to simplify treatment, outpatient management using LMWH has been proposed for these patients. This management strategy has now been shown to be as safe and effective as hospital treatment in a number of large clinical trials. The question remains whether such an out-of-hospital treatment strategy actually reduces costs. This paper summarizes the economic evaluations reported in the literature. Two large economic evaluations, based on prospectively collected data on resource use, have been reported. Both pointed to a large reduction in costs of 60% or more. The size of the cost reduction depends on the proportion of patients managed at home. Several studies show that approximately 80% qualify for out-of-hospital treatment. Local facilities for organizing home care may put an upper limit on this proportion. From a societal perspective, the economic evidence in favour of outpatient treatment with LMWH presents a rare case of dominance: a situation of reduced costs with no concessions in clinical outcomes. Nevertheless, attention should be paid to the parties that will bear the healthcare costs generated by the replacement of inpatient care by outpatient care.