I Garcia-Zozaya1. 1. University of Louisville Department of Internal Medicine, KY, USA.
Abstract
BACKGROUND: Total joint replacements are high-risk procedures for development of deep venous thrombosis (DVT) and pulmonary embolism (PE), therefore, routine pharmacological prophylaxis should be instituted in all cases. Cost-containment has become an important factor with the present changes in health care. This report presents an economic model for DVT prophylaxis after total hip and total knee arthroplasty (THA & TKA) that approximates closely to the current standards in orthopedic practice, and encourages the balance of clinical and economic considerations in patient care management. METHODS: A simplified cost-effectiveness (cost-minimization) analysis, from the consumer's perspective, between Warfarin and Enoxaparin for DVT prophylaxis after THA and TKA, for a total of 15 days, in both inpatient and outpatient settings was used. The costs of drugs, laboratory, and home care services were evaluated through surveying three different providers in each category and obtaining the mean value for each of the services supplied. All providers were located within the Louisville, KY, metropolitan area. Data collection took place in October 1996. RESULTS: The main outcome measure was the difference in cost between the two drugs when all factors associated with therapy were considered. The overall cost of DVT prophylaxis with Enoxaparin was somewhat less expensive ($925.38) when compared to Warfarin ($971.77). CONCLUSIONS: Within the limitations of this study Enoxaparin was slightly more cost-effective than Warfarin for venous thromboembolism prophylaxis after total hip and knee arthroplasty.
BACKGROUND: Total joint replacements are high-risk procedures for development of deep venous thrombosis (DVT) and pulmonary embolism (PE), therefore, routine pharmacological prophylaxis should be instituted in all cases. Cost-containment has become an important factor with the present changes in health care. This report presents an economic model for DVT prophylaxis after total hip and total knee arthroplasty (THA & TKA) that approximates closely to the current standards in orthopedic practice, and encourages the balance of clinical and economic considerations in patient care management. METHODS: A simplified cost-effectiveness (cost-minimization) analysis, from the consumer's perspective, between Warfarin and Enoxaparin for DVT prophylaxis after THA and TKA, for a total of 15 days, in both inpatient and outpatient settings was used. The costs of drugs, laboratory, and home care services were evaluated through surveying three different providers in each category and obtaining the mean value for each of the services supplied. All providers were located within the Louisville, KY, metropolitan area. Data collection took place in October 1996. RESULTS: The main outcome measure was the difference in cost between the two drugs when all factors associated with therapy were considered. The overall cost of DVT prophylaxis with Enoxaparin was somewhat less expensive ($925.38) when compared to Warfarin ($971.77). CONCLUSIONS: Within the limitations of this study Enoxaparin was slightly more cost-effective than Warfarin for venous thromboembolism prophylaxis after total hip and knee arthroplasty.