Cost-Minimization Analysis of Multidose Enoxaparin in the Hospital Setting: Impact of Dosing Accuracy on Severe Adverse Events

Abstract

Introduction: Medication errors involving anticoagulants are significant clinical concerns, directly impacting patient safety. Low molecular weight heparins, such as enoxaparin, are frequently associated with dosing errors in hospital settings, largely due to challenges in adjusting doses accurately based on body weight. Methods: A cost-minimization analysis was conducted from the perspectives of Brazil’s public healthcare system and private health insurance, comparing the traditional prefilled syringe formulation of enoxaparin with a new multidose vial presentation. A decision tree model was developed to estimate clinical and economic outcomes in a hypothetical cohort of 1,000 hospitalized patients, accounting for dosing errors (overdose and underdose) and related adverse events. Direct medical costs were derived from official Brazilian sources and published literature. The multidose formulation was associated with a 20% reduction in dosing errors, with sensitivity analyses exploring reductions of 5% and 35%. The time horizon was the average hospitalization period, and modeling was performed in Excel using 2025 Brazilian Reais. Results: The multidose presentation reduced total treatment and complication costs. Estimated savings reached R$312.18 per patient in the SUS and R$699.87 in private care. Major bleeding was the primary cost driver. Even under conservative assumptions, the intervention remained cost-effective. Conclusion: Enoxaparin requires careful management. The multidose formulation enables precise dosing, reduces medication errors and adverse events, and offers consistent clinical and economic benefits, supporting safer and more efficient anticoagulation in hospital settings.