The challenge from Dr Lee Goldman and Dr Jeffrey Ginsberg in their editorial focussed around the cost of the treatment compared to the relative benefit, a growing debate in American medicine.

The study published in the NEJM proved that a blood-thinning medicine could prevent problems from worsening in some people with a sometimes painful, usually short-term and non-fatal, blood clot near the surface of the leg, called superficial-vein thrombosis.

The editorial, however, challenged the costs of the treatment (ranging from US$2,124–7,380 per patient to receive injections for 45 days) to prevent one out of 88 patients from having a more dangerous, but rarely fatal, deep vein clot.

The issue of cost-effectiveness is becoming a hot topic as more Americans become eligible for Medicare insurance, drug rebates increase and new healthcare reform aims to bring affordable health care to 30 million more people by 2019.

Healthcare expenditure in the US is already higher than any other country, and currently spends about 18% of the gross domestic product on health care.

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