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Based on the abstract below, please critique the study by answering the questions that follow. Please note that this abstract may no longer reflect current evidence-based practice, as newer anticoagulants are now sometimes used in place of warfarin.
ABSTRACT
TITLE: Cost Analysis of Outpatient Treatment of Deep Vein Thrombosis
BACKGROUND: When patients have the complication of deep vein thrombosis (DVT) after surgery, the standard anticoagulation treatment includes heparin—either intravenous unfractionated heparin (UFH) or a subcutaneous low-molecular-weight heparin (LMWH) product—in combination with warfarin. After the patient's international normalized ratio (INR) is greater than 2.0, the patient discontinues the heparin product but continues on oral warfarin for 3 to 6 months. LMWH products have been approved for outpatient use.
OBJECTIVE: The objective of this study was to retrospectively measure the costs of treating patients with uncomplicated DVT discharged with either oral warfarin alone or a combination of oral warfarin and LMWH.
METHODS: Medical and prescription claims for Health Plan X were assessed. Costs to the health plan for hospitalized patients discharged in 2006 with a diagnosis of uncomplicated DVT were included in the analysis, and their claims history was followed for 1 year after initial hospital discharge date.
RESULTS: Compared with patients discharged on warfarin alone, the outpatient pharmacy costs were, on average, $750 higher for the patients discharged on the LMWH and warfarin combination, but the average hospital length of stay was 2 days less, resulting in a savings, on average of $2,300 in hospitalization costs. Therefore, mean total costs to the health plan per patient were $1,550 less for patients discharged on combination therapy. One-year follow-up showed no differences in readmission rates due to DVT for the two groups of patients, indicating similar effectiveness.
CONCLUSIONS: Outpatient anticoagulation therapy for uncomplicated DVT with a combination of LMWH and warfarin had higher outpatient pharmacy costs but lower hospitalization costs compared with warfarin alone, which resulted in overall savings to Health Plan X.
Abstract Reference:
Rascati, Karen L. Essentials of Pharmacoeconomics, Wolters Kluwer, 2013. ProQuest Ebook Central, https://ebookcentral-proquest-com.proxy.lib.ohio-state.edu/lib/ohiostate-ebooks/detail.action?docID=4625043.)
Questions:
Was the title appropriate? Why or why not?
What was the objective of the study? Was this clear?
Were you able to determine the perspective? If so, what was it?
Which of the four types of pharmacoeconomic analyses was conducted? Why?
Was either cost adjustment (also called annuitization) or discounting conducted? If so, was it appropriate?
Was a sensitivity analysis conducted? If so, on what estimate(s)?
Were limitations addressed? If so, what were they?
Was an unbiased summary of the results presented for the conclusion? Why or why not?
Step 1/2
1. Was the title appropriate? Why or why not?
Yes, the title is appropriate as it accurately reflects the objective of the study which is to measure the costs of treating patients with deep vein thrombosis (DVT) in an outpatient setting.
2. What was the objective of the study? Was this clear?
The objective of the study was to retrospectively measure the costs of treating patients with uncomplicated DVT discharged with either oral warfarin alone or a combination of oral warfarin and low-molecular-weight heparin (LMWH). This objective is clear from the abstract.
3. Were you able to determine the perspective? If so, what was it?
Yes, the perspective of the study is the cost analysis from the health plan's point of view, as medical and prescription claims for "Health Plan X" were assessed and the costs to the health plan were analyzed.
4. Which of the four types of pharmacoeconomic analyses was conducted? Why?
The type of pharmacoeconomic analysis conducted in this study is cost analysis, which measures the cost of an intervention in comparison to another intervention or to no intervention at all. The study was conducted to determine the cost savings to Health Plan X from the combination therapy of LMWH and warfarin compared to warfarin alone.
Step 2/2
5. Was either cost adjustment (also called annuitization) or discounting conducted? If so, was it appropriate?
The abstract does not mention whether cost adjustment or discounting was conducted, so it cannot be determined whether it was appropriate or not.
6. Was a sensitivity analysis conducted? If so, on what estimate(s)?
The abstract does not mention a sensitivity analysis being conducted, so it cannot be determined what estimate(s) it was performed on.
7. Were limitations addressed? If so, what were they?
The abstract does not mention any limitations being addressed, so it cannot be determined what the limitations of the study were.
8. Was an unbiased summary of the results presented for the conclusion? Why or why not?
Yes, an unbiased summary of the results was presented in the conclusion, stating that the combination therapy of LMWH and warfarin had higher outpatient pharmacy costs but lower hospitalization costs compared to warfarin alone, resulting in overall savings to Health Plan X.
Final answer
1. Was the title appropriate? Why or why not?
Yes, the title is appropriate as it accurately reflects the objective of the study which is to measure the costs of treating patients with deep vein thrombosis (DVT) in an outpatient setting.
2. What was the objective of the study? Was this clear?
The objective of the study was to retrospectively measure the costs of treating patients with uncomplicated DVT discharged with either oral warfarin alone or a combination of oral warfarin and low-molecular-weight heparin (LMWH). This objective is clear from the abstract.
3. Were you able to determine the perspective? If so, what was it?
Yes, the perspective of the study is the cost analysis from the health plan's point of view, as medical and prescription claims for "Health Plan X" were assessed and the costs to the health plan were analyzed.
4. Which of the four types of pharmacoeconomic analyses was conducted? Why?
The type of pharmacoeconomic analysis conducted in this study is cost analysis, which measures the cost of an intervention in comparison to another intervention or to no intervention at all. The study was conducted to determine the cost savings to Health Plan X from the combination therapy of LMWH and warfarin compared to warfarin alone.
5. Was either cost adjustment (also called annuitization) or discounting conducted? If so, was it appropriate?
The abstract does not mention whether cost adjustment or discounting was conducted, so it cannot be determined whether it was appropriate or not.
6. Was a sensitivity analysis conducted? If so, on what estimate(s)?
The abstract does not mention a sensitivity analysis being conducted, so it cannot be determined what estimate(s) it was performed on.
7. Were limitations addressed? If so, what were they?
The abstract does not mention any limitations being addressed, so it cannot be determined what the limitations of the study were.
8. Was an unbiased summary of the results presented for the conclusion? Why or why not?
Yes, an unbiased summary of the results was presented in the conclusion, stating that the combination therapy of LMWH and warfarin had higher outpatient pharmacy costs but lower hospitalization costs compared to warfarin alone, resulting in overall savings to Health Plan X.
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