H KULKARNI1, B JOSEPH1
1East Metro Health Services – ARMADALE HEALTH SERVICES, ARMADALE, AUSTRALIA
Background: Comparison of costs of effective dose of LMWH and UH for HDF is performed. LMWH may offer benefit of single dose administration.
Aim: To study the cost effectiveness of use of LMWH and UH in HDF population.
Method: Clexane® (Enoxaparin) was used as LMWH in a prospective cross over study. 47 patients on HDF were switched from UH to LMWH. Effective dose of LMWH was established over 10 week by using standardised clotting scale. Costs of effective doses of the LMWH and UH and consumables were compared. Adverse effects and nursing resources were evaluated.
Results: Median (IQR) UH dose in Units and Units/Kg (n =47) was 4500 Units (4000 – 6625) and 64 U/kg (53 – 83) respectively. Costs per session using 1(n=26) and 2 (n=21) vials of UH were $1.49 and $2.66 respectively. Median (IQR) LMWH dose in mg and mg/Kg (n 47) was 40mg (4000 – 6625) and 0.60mg/kg (0.52- 0.74) respectively. Effective dose of LMWH varied from 20 mg (n=1), 40 mg (n =27); 60 mg (n= 4), 80 mg (n= 6), 80 mg in split doses (n= 5) and 100 mg in split doses (n =4). Costs for LMWH were 20 mg ($ 3.19); 40 mg ($ 3.62), 60 mg ($ 5.17), 80 mg ($ 5.95), Split dose 80 mg ($ 7.24) and split dose 100mg ($ 8.79). Costs for UH and LMWH for the unit per HDF session was $ 94.6 and $ 228.67 respectively; which accounts to yearly costs of $ 14575.60 and $ 35672.52 respectively.
Conclusion: Costs of use of Clexane® is significantly higher and was associated with 242 % increase in the yearly costs for the unit.
Boby Joseph is Manager of the Armadale Dialysis Unit and has almost completed the Renal Nurse Practitioner degree. Clinical research in dialysis which can change the practice is his interest