Justifying high-cost anticoagulant therapy

Abstract

The application of pharmacoeconomics for choosing low-molecular-weight heparins (LMWHs) to facilitate better clinical and economic outcomes is examined. Today's pharmacy paradigm challenges pharmacists to weigh budgetary concerns with optimal patient outcomes to ensure medication-use practices represent the interests of both the health care system and the patient. Pharmacy is attempting to apply pharmacoeconomics to daily practice to influence these outcomes. By using pharmacoeconomic principles, methods, and data, pharmacists can project the impact of a new drug, such as LMWHs, on a pharmacy budget or overall hospital expenditures. LMWHs have demonstrated superior clinical outcomes and overall cost-of-care advantages over traditional anticoagulant agents. Although LMWHs are more expensive than unfractionated heparins, the costs are partially offset by reductions of hospital length of stay, rates of heparin-induced thrombocytopenia, and the monitoring of certain laboratory test values. LMWHs also facilitate the use of bridge therapy for patients with venous thromboembolism, atrial fibrillation, or prosthetic-valve replacements, allowing drastic cost savings for health systems that far offset their acquisition costs. LMWHs can also provide health care systems the opportunity to implement targeted dose-reduction and rounding programs and appropriate dosing guidelines. Pharmacoeconomics provides pharmacy professionals a method to document potential cost savings, cost avoidances, and costs offsets as well as a means to justify additional pharmacy staff. Applying pharmacoeconomics when choosing LMWHs for anticoagulant therapy can assist pharmacy practitioners in facilitating better clinical and economic outcomes.