Cost-effectiveness of dalteparin vs unfractionated heparin for the prevention of venous thromboembolism in critically ill patients

JAMA. 2014 Nov 26;312(20):2135-45. doi: 10.1001/jama.2014.15101.


Importance: Venous thromboembolism (VTE) is a common complication of acute illness, and its prevention is a ubiquitous aspect of inpatient care. A multicenter blinded, randomized trial compared the effectiveness of the most common pharmocoprevention strategies, unfractionated heparin (UFH) and the low-molecular-weight heparin (LMWH) dalteparin, finding no difference in the primary end point of leg deep-vein thrombosis but a reduced rate of pulmonary embolus and heparin-induced thrombocytopenia among critically ill medical-surgical patients who received dalteparin.

Objective: To evaluate the comparative cost-effectiveness of LMWH vs UFH for prophylaxis against VTE in critically ill patients.

Design, setting, and participants: Prospective economic evaluation concurrent with the Prophylaxis for Thromboembolism in Critical Care Randomized Trial (May 2006 to June 2010). The economic evaluation adopted a health care payer perspective and in-hospital time horizon; derived baseline characteristics and probabilities of intensive care unit and in-hospital events; and measured costs among 2344 patients in 23 centers in 5 countries and applied these costs to measured resource use and effects of all enrolled patients.

Main outcomes and measures: Costs, effects, incremental cost-effectiveness of LMWH vs UFH during the period of hospitalization, and sensitivity analyses across cost ranges.

Results: Hospital costs per patient were $39,508 (interquartile range [IQR], $24,676 to $71,431) for 1862 patients who received LMWH compared with $40,805 (IQR, $24,393 to $76,139) for 1862 patients who received UFH (incremental cost, -$1297 [IQR, -$4398 to $1404]; P = .41). In 78% of simulations, a strategy using LMWH was most effective and least costly. In sensitivity analyses, a strategy using LMWH remained least costly unless the drug acquisition cost of dalteparin increased from $8 to $179 per dose and was consistent among higher- and lower-spending health care systems. There was no threshold at which lowering the acquisition cost of UFH favored prophylaxis with UFH.

Conclusions and relevance: From a health care payer perspective, the use of the LMWH dalteparin for VTE prophylaxis among critically ill medical-surgical patients was more effective and had similar or lower costs than the use of UFH. These findings were driven by lower rates of pulmonary embolus and heparin-induced thrombocytopenia and corresponding lower overall use of resources with LMWH.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anticoagulants / adverse effects
  • Anticoagulants / economics*
  • Anticoagulants / therapeutic use
  • Cost-Benefit Analysis
  • Critical Illness / economics*
  • Dalteparin / adverse effects
  • Dalteparin / economics*
  • Dalteparin / therapeutic use
  • Female
  • Health Expenditures / statistics & numerical data*
  • Health Services / statistics & numerical data
  • Heparin / adverse effects
  • Heparin / economics*
  • Heparin / therapeutic use
  • Hospitalization / economics
  • Humans
  • Insurance, Health / economics
  • Intensive Care Units
  • Male
  • Middle Aged
  • Prospective Studies
  • Pulmonary Embolism / economics
  • Pulmonary Embolism / prevention & control
  • Randomized Controlled Trials as Topic
  • Thrombocytopenia / chemically induced
  • Thrombocytopenia / economics
  • Venous Thromboembolism / economics
  • Venous Thromboembolism / prevention & control*


  • Anticoagulants
  • Heparin
  • Dalteparin