[Are 55 cents always better value than 90 cents for venous thromboembolism prophylaxis? Comparison of three low-molecular-weight heparins with regard to economics and guideline compliance].

Abstract

BACKGROUND:

Four low-molecular-weight heparins with different dosage regimens are allowed for venous thromboembolism prophylaxis in patients with a high risk of thromboembolism in Germany. If comparison is made purely on the basis of drug costs, multi-dose vials are the favourable solution. We try to answer the question whether the choice of low-molecular-weight heparin influences the compliance with the S2 guideline "Inpatient and outpatient thromboembolism prophylaxis in surgery and perioperative medicine." Beyond that we ask if multi-dose administration is superior to the pre-filled syringe when total costs are calculated on the basis of procedure and technical application.

PATIENTS AND METHODS:

After training the nursing and medical staff in guideline-compliant implementation of thromboembolism prophylaxis with pre-filled certoparin safety syringes (03/09-05/09) or nadroparin (06/09-08/09) and enoxaparin (02/10-04/10) from multi-dose vials, we calculated the total costs on the basis of procedure and technical application. Furthermore, the satisfaction of the nursing staff was interrogated and the proportion of non-guideline-compliant prescriptions was determinated prospectively on the basis of a total of 388 patient files.

RESULTS:

When total costs are calculated on the basis of procedure and technical application, the costs for nadroparin are 1.16 €/0.3 mL, 1.30 €/0.4 mL and 1.58 €/0.6 mL, for enoxaparin 1.04 €/20 and 1.42 €/40, and for certoparin 1.25 €/pre-filled safety syringe. The pre-filled certoparin safety syringe made a very good overall impression on the nursing staff (versus sufficient for nadroparin and enoxaparin). Guideline-compliance was achieved in 100 % with body weight- and risk-independent certoparin, in 79.4 % with risk-adapted enoxaparin, and in 66.4 % with body weight- and risk-dependent nadroparin.

CONCLUSION:

The complexity of the dosage regimen of a low-molecular-weight heparin has a decisive influence on guideline-compliance. By calculating total costs on the basis of procedure and technical application multi-dose vials only offer a price advantage in patients with a low or moderate risk of thromboembolism compared with pre-filled safety syringes in the venous thromboembolism prophylaxis of orthopaedic and trauma surgery patients.

• Authors: T Seidl, H-H Trouillier
• Journal: Zeitschrift fur Orthopadie und Unfallchirurgie (Z Orthop Unfall) Vol. 151 Issue 5 Pg. 520-4 (Oct 2013) ISSN: 1864-6743 [Electronic] Germany
• Vernacular Title: Sind bei der venösen Thrombembolieprophylaxe 55 Cent immer günstiger als 90 Cent? - Vergleich von 3 niedermolekularen Heparinen hinsichtlich Wirtschaftlichkeit und Leitlinien-Compliance.
• PMID: 24129724 (Publication Type: Clinical Trial, Comparative Study, Journal Article)
• Copyright: Georg Thieme Verlag KG Stuttgart · New York.

Chemical References

• Heparin, Low-Molecular-Weight

Topics

• Attitude of Health Personnel
• Cost-Benefit Analysis
• Germany (epidemiology)
• Guideline Adherence (statistics & numerical data)
• Health Care Costs (statistics & numerical data)
• Heparin, Low-Molecular-Weight (classification, economics, standards, therapeutic use)
• Humans
• Practice Guidelines as Topic
• Practice Patterns, Nurses' (standards, statistics & numerical data)
• Prevalence
• Risk Factors
• Treatment Outcome
• Venous Thromboembolism (prevention & control)