Brendan M. Reilly, MD; Arthur Evans, MD, MPH
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Reilly B., Evans A.; Cost-Effectiveness of Low-Molecular-Weight Heparins for Deep Venous Thrombosis. Ann Intern Med. 2000;132:508. doi: 10.7326/0003-4819-132-6-200003210-00019
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Published: Ann Intern Med. 2000;132(6):508.
TO THE EDITOR:
We enjoyed Gould and colleagues' cost-effectiveness analysis of low-molecular-weight heparin (LMWH) for deep venous thrombosis and their meta-analysis (1, 2). However, the conclusion that “LMWHs are highly cost-effective for inpatient management of venous thrombosis” seems overdrawn and misleading.
The principal result of their meta-analysis (and the linchpin of the cost-effectiveness analysis) is that “LMWH treatment reduces mortality rates after acute DVT [deep venous thrombosis].” Yet the authors admitted that the mechanism for this reduction is mysterious; it was not due to a reduction in deaths from recurrent thromboembolism or bleeding. If a few days of LMWH treatment reduces mortality months later through a mechanism unrelated to its effect on thromboembolism or bleeding, further study is warranted. Its biological implausibility, however, does not inspire confidence in the cost-effectiveness analysis.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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