Prophylaxis for venous thromboembolism in hip fracture surgery: total costs and cost effectiveness in The Netherlands.

Fracture of the hip is one of most significant risk factors for development of deep vein thrombosis (DVT) and its complications. A number of pharmacological prophylactic methods are currently available which can reduce the incidence of postoperative thromboembolism in patients undergoing surgery for fracture of the hip. A retrospective analysis of controlled clinical studies was performed to examine in this patient group the total cost of prevention and treatment, and the cost effectiveness in terms of lives saved, of 5 prophylactic regimens--oral anticoagulants, dextran, low dose heparin, low molecular weight (LMW)-heparin and danaparoid sodium--compared with clinical diagnosis and conventional treatment of DVT only. Our results show that the total cost, including the savings in treatment of the complications of DVT, of each prophylactic regimen is less than the total cost of no prophylaxis. Thus, prophylaxis may not only save lives but may also lead to lower costs of care (including prophylaxis costs). The total cost of the new antithrombotic danaparoid sodium is less than that of the other forms of prophylaxis considered and danaparoid sodium appears to be the most cost-effective modality. We conclude that general use of danaparoid sodium in surgery for hip fracture is the most efficient approach to decreasing the incidence of postoperative morbidity and mortality and reducing healthcare expenses for the complications of DVT.