Cheaper, but is it more cost-effective?

In treatment of venous thromboembolism (VTE), low molecular weight heparin (LMWH) has been proven to be equally effective, safe (if not safer), requires less monitoring but is said to be more expensive.

Is it really the case?

This inquisitive young medical officer went to find out.

Say a patient requires a single bolus IV heparin 5000u followed by 1000u infusion per hour, an average patient requires 5-6 ampoules of 5ml heparin (1000u/ml) per day. With each ampoule costing ~ RM 5, the daily cost comes to RM 25-30.

How much does LMWH cost?

Daily cost of enoxaparin (2 pre-filled syringes of 60mg each) is ~ RM 48. Therefore, using enoxaparin instead of unfractionated heparin will result in extra drug expenditure of ~ RM 18-23/day.

However, is it more expensive?

LMWH requires less monitoring, is administered via subcutaneous route twice daily (OD for certain LMWH).

What have we saved here?

Tangible saving :
4 times of PTT per day

Intangible saving :
Avoidance of pricking the patient, needle-prick injury for HCWs
Doing away with infusion pump, setting branulas
Do not irritate MLTs (by insisting them on doing PTT stat, then calling them 15 minutes later to trace the result, only to be told it takes at least ½ hour to be processed!)

How much does it mean in ringgit and sen?
Each PTT test costs ~RM 7. Daily cost = RM 7 x 4 = RM 28

If the source of origin of the medication is not an issue, should we consider LMWH as first line in treatment of VTE?

Conflict of interest:
No sponsored conferences, certainly not monetary incentive. Guilty of going out for lunch with medical representatives, though can’t remember anyone of them from manufacturers of LMWH. Vulnerable to free meals by HOs/JMOs too, if this saves them from doing 6-hourly PTT :-)