Yun Bao1, Gang Zhao2, Shuli Qu3, Tengbin Xiong3, Xingxing Yao4, Bin Wu5. 1. Department of Pharmacy, Gansu Provincial Hospital, Gansu, China. 2. Department of General Surgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China. 3. RWE Solution and HEOR, Quintiles IMS, Shanghai, China. 4. HEOR, Sanofi China, Shanghai, China. 5. Medical Decision and Economic Group, Department of Pharmacy, Ren Ji Hospital, South Campus, School of Medicine, Shanghai Jiao Tong University, Shanghai, China. scilwsjtu-wb@yahoo.com.
Abstract
BACKGROUND: Venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE), is an important cause of post-surgery morbidity and mortality. However, it is unclear whether thromboprophylaxis with the low-molecular-weight heparin (LMWH) enoxaparin after non-orthopedic surgery could balance the cost and clinical outcomes or not. OBJECTIVES: The purpose of this research was to evaluate the cost-effectiveness of enoxaparin for the universal prophylaxis of VTE and associated long-term complications in patients after non-orthopedic surgery compared with no prevention in a Chinese healthcare setting. METHODS: A decision model, which included both acute VTE and long-term complications, was developed to assess the economic outcomes of the two strategies for patients after non-orthopedic surgery. Quality-adjusted life years (QALYs) and direct medical costs were measured over a 5-year horizon. Incremental cost-effectiveness ratios (ICERs) were calculated. RESULTS: Compared with no prevention, patients under enoxaparin treatment with Caprini risk scores of 3-4, 5-6, 7-8, and ≥ 9 increased by 0.012, 0.017, 0.034, and 0.102 in QALYs, respectively. The results were either that ICERs of thromboprophylaxis with enoxaparin over no prevention were lower than the thresholds or that thromboprophylaxis with enoxaparin was dominant. For patients with a Caprini risk score ≥ 9, thromboprophylaxis with enoxaparin is dominant across the whole drug use duration range. The sensitivity analysis confirmed the results. CONCLUSIONS: As the first analysis evaluating the economic outcomes of enoxaparin in patients undergoing general non-orthopedic surgery, this study suggests that thromboprophylaxis with enoxaparin is highly cost-effective compared with no prevention in patients with Caprini risk score ≥ 3.
BACKGROUND:Venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE), is an important cause of post-surgery morbidity and mortality. However, it is unclear whether thromboprophylaxis with the low-molecular-weight heparin (LMWH) enoxaparin after non-orthopedic surgery could balance the cost and clinical outcomes or not. OBJECTIVES: The purpose of this research was to evaluate the cost-effectiveness of enoxaparin for the universal prophylaxis of VTE and associated long-term complications in patients after non-orthopedic surgery compared with no prevention in a Chinese healthcare setting. METHODS: A decision model, which included both acute VTE and long-term complications, was developed to assess the economic outcomes of the two strategies for patients after non-orthopedic surgery. Quality-adjusted life years (QALYs) and direct medical costs were measured over a 5-year horizon. Incremental cost-effectiveness ratios (ICERs) were calculated. RESULTS: Compared with no prevention, patients under enoxaparin treatment with Caprini risk scores of 3-4, 5-6, 7-8, and ≥ 9 increased by 0.012, 0.017, 0.034, and 0.102 in QALYs, respectively. The results were either that ICERs of thromboprophylaxis with enoxaparin over no prevention were lower than the thresholds or that thromboprophylaxis with enoxaparin was dominant. For patients with a Caprini risk score ≥ 9, thromboprophylaxis with enoxaparin is dominant across the whole drug use duration range. The sensitivity analysis confirmed the results. CONCLUSIONS: As the first analysis evaluating the economic outcomes of enoxaparin in patients undergoing general non-orthopedic surgery, this study suggests that thromboprophylaxis with enoxaparin is highly cost-effective compared with no prevention in patients with Caprini risk score ≥ 3.
Authors: Christopher J Pannucci; Steven H Bailey; George Dreszer; Christine Fisher Wachtman; Justin W Zumsteg; Reda M Jaber; Jennifer B Hamill; Keith M Hume; J Peter Rubin; Peter C Neligan; Loree K Kalliainen; Ronald E Hoxworth; Andrea L Pusic; Edwin G Wilkins Journal: J Am Coll Surg Date: 2010-11-18 Impact factor: 6.113
Authors: P Prandoni; S Villalta; P Bagatella; L Rossi; A Marchiori; A Piccioli; E Bernardi; B Girolami; P Simioni; A Girolami Journal: Haematologica Date: 1997 Jul-Aug Impact factor: 9.941
Authors: Vittorio Pengo; Anthonie W A Lensing; Martin H Prins; Antonio Marchiori; Bruce L Davidson; Francesca Tiozzo; Paolo Albanese; Alessandra Biasiolo; Cinzia Pegoraro; Sabino Iliceto; Paolo Prandoni Journal: N Engl J Med Date: 2004-05-27 Impact factor: 91.245