Background: Venous thromboembolism (VTE) is a preventable cause of morbidity and mortality in the hospital setting. While respiratory symptoms are the fundamental feature of COVID-19 infection, VTE is a known sequelae given the hypercoagulable state of the disease. Therefore, it is common for hospitalists to prescribe prophylactic anticoagulation in the inpatient setting for patients with COVID-19, especially for those with risk factors. This study presents a break-even analysis comparing two commonly used anticoagulant agents in the prevention of VTE for hospitalized patients with COVID-19.
Methods: The product costs of one week of heparin (5000 units TID) and enoxaparin (40 mg BID) were obtained from our institution’s purchasing records. The estimated one-month cost of treatment for a VTE was obtained from the literature [1]. The TriNetX Research Database was then queried to determine the rate of VTE in patients hospitalized with acute respiratory failure secondary to COVID-19. A break-even analysis was then performed to determine the final VTE rate that must be achieved to make an anticoagulant cost-effective.
Results: A cohort of 116,613 patients with COVID-19 and acute respiratory failure was identified. The mean age was 61.2, and there were 55% males and 45% females. The VTE rate in this cohort was found to be 8.4%. The estimated 1-month cost of treating a VTE was $14,263. Costing $82.11, heparin (5000 units TID) was determined to be cost-effective if the initial VTE rate decreased by an ARR of 0.58%. Likewise, at a cost of $210.49, enoxaparin (40 mg BID) was also determined to be cost-effective if the initial VTE rate decreased by an ARR of 1.48%.
Conclusions: Using a large cohort, we demonstrated the high rate of VTE in patients hospitalized with COVID-19. We also show that prophylactic heparin and enoxaparin can be highly cost-effective. This break-even analysis provides an economic model that can be easily applied to many areas of hospital medicine.
