Heparin choice can impact costs, according to a study published online Nov. 1 in JAMA. The economic analysis found median hospital costs were $1,297 less per patient with low-molecular-weight heparin (LMWH) dalteparin as opposed to unfractionated heparin.

Run concurrently with the Prophylaxis for Thromboembolism in Critical Care Trial (PROTECT), Robert A. Fowler, MDCM, MS, of the Sunnybrook Health Sciences Center at the University of Toronto, and colleagues reviewed the trial data from a cost-comparison perspective.

The original PROTECT study reviewed outcomes for patients randomized to either once daily dalteparin and a placebo or twice daily unfractionated heparin as a thromboprophylaxis. Differences in venous thromboembolism, deep vein thrombosis episodes, pulmonary embolism, major bleeding, thrombocytopenia and death rates were recorded and analyzed via an intention-to-treat method.

PROTECT enrolled 3,746 patients between 2006 and 2007; the cost analysis was performed on a subgroup of 2,344 patients from 23 hospitals across Canada, Australia, Saudi Arabia, Brazil and the U.S. Slightly more patients were in the unfractionated heparin group (1,175 vs. 1,169) than in the dalteparin group.

Although unfractionated heparin cost less by unit, higher per-day institutional costs and personnel costs contributed to making it less favorable, as did repeated dosing and difficulty maintaining treatment range.

Total cost difference favored dalteparin by $2,773,635. Fowler et al noted that unfractionated heparin cost $1,297 more per patient than dalteparin in a median difference analysis and it cost $1,490 more per patient when comparing mean costs.

They also found that a more than 20-fold increase in cost would be needed before dalteparin was no longer cost effective. No threshold was found for lowering unfractionated heparin’s cost to make it more favorable.

“These findings are important for the care of critically ill patients because they provide a cost-minimization rationale that complements clinical effectiveness knowledge from PROTECT,” they wrote.