Deep venous thrombosis: a new task for primary health care A randomised economic study of outpatient and inpatient treatment

• Published in: Scandinavian journal of primary health care Vol. 22; no. 1; pp. 44 - 49
• Main Authors: Bäckman, Karin, Carlsson, P., Kentson, Magnus, Hansen, Sören, Engquist, Leif, Hallert, Claes
• Format: Journal Article
• Language: English
• Published: United States Informa UK Ltd 01.03.2004; Taylor & Francis
• Subjects: Administration, Cutaneous; Adult; Aged; Aged, 80 and over; Ambulatory care; Anticoagulants - therapeutic use; Costs; Costs and cost analysis; Dalteparin - therapeutic use; Deep vein thrombosis; Direct Service Costs - statistics & numerical data; Female; Health Care Costs - statistics & numerical data; Hospital Costs - statistics & numerical data; Hospitalization - economics; Hospitals; Humans; Low-molecular-weight heparin; Male; MEDICIN; MEDICINE; Middle Aged; Primary health care; Primary Health Care - economics; Sweden; Treatment; Treatment Outcome; Venous thrombosis; Venous Thrombosis - drug therapy; Venous Thrombosis - economics; Sweden
• ISSN: 0281-3432; 1502-7724; 1502-7724
• DOI: 10.1080/02813430310003543

Objective A health economic evaluation of two alternative treatment settings, inpatient care and outpatient care, for acute deep venous thrombosis.Design A randomised multicentre trial in a defined population in regular clinical practice.Setting Hospitals and related health care centres in the Jönköping county council in Sweden.Interventions Patients were randomised to either an inpatient strategy (n=66) or an outpatient strategy (n=65) using low-molecular-weight heparin, dalteparin, administered subcutaneously once daily and adjusted for body weight.Subjects Of 224 eligible patients, 131 entered the trial and 124 completed the economic part of the study.Main outcome measures Direct medical and direct non-medical costs during a 3-month period.Results Total direct costs were higher for those in the inpatient strategy group, i.e. Swedish Crowns (SEK) 16 400 per patient (Euro 1899) compared to SEK 12 100 per patient (Euro 1405) in the outpatient strategy group (p<0.001). More patients in the outpatient group received assistance when they returned home. Few patients in either group reported sick leave. There was no difference in total number of days between the two groups.Conclusions Total direct costs were significantly lower for the outpatient treatment strategy for deep venous thrombosis compared to the inpatient treatment strategy. No significant difference in health impact could be detected. Deep venous thrombosis can to a greater extent than previously be treated in primary care, safely, at a lower cost, and in accordance with patient preferences.