Dermatan sulfate versus unfractionated heparin for the prevention of venous thromboembolism in patients undergoing surgery for cancer. A cost-effectiveness analysis.
BACKGROUND
In a recent clinical trial, dermatan sulfate was found to be more effective than unfractionated heparin (UFH), but equally well tolerated, for the prevention of deep vein thrombosis (DVT) after major surgery for cancer.


OBJECTIVE
To perform a cost-effectiveness analysis of dermatan sulfate versus UFH in this clinical setting.


METHODS
This was a retrospective economic analysis using data from a randomised clinical trial, and was performed from the hospital perspective.


METHODS
Clinical event rates were extrapolated from the observed venographic DVT rates, using appropriate assumptions from the scientific literature. The economic effects of switching DVT prophylaxis from UFH to dermatan sulfate and the potential lives saved were assessed by a predictive decision model.


RESULTS
The per patient cost, including the burden of residual thromboembolic events and major bleeding complications, was estimated to be 154 euros (EUR) for dermatan sulfate and EUR185 for UFH (1998 values). With reference to a potential target population of 60,000 patients/year undergoing surgery for cancer in Italy, the total prophylaxis-associated cost was EUR9,258,000 for dermatan sulfate and EUR11,096,000 for UFH, whereas the potential deaths from prophylaxis failure were 204 and 392, respectively. This represented a saving of EUR1,838,000 and 188 potential lives per year with the dermatan sulfate option. The final costs and effects were mainly sensitive to variations in the rates of DVT and pulmonary embolism, and to the possible need for 1 extra day of hospitalisation because of the earlier preoperative initiation of dermatan sulfate prophylaxis.


CONCLUSIONS
Dermatan sulfate is more cost effective than UFH for the prevention of postoperative venous thromboembolism in patients with cancer. If the hospital stay needs to be prolonged, then the dermatan sulfate option may involve a small additional cost (EUR47) per potential life saved.
Department of Experimental Medicine and Pathology, School of Medicine, University La Sapienza, Rome, Italy. ermanno.attanasio@uniroma1.it
E
E
Attanasio
P
P
Russo
G
G
Carunchio
L
L
Caprino
D000328:Adult; D000925:Anticoagulants / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D003871:Dermatan Sulfate / Q000191:economics* / Q000627:therapeutic use; D017048:Health Care Costs; D006493:Heparin / Q000191:economics* / Q000627:therapeutic use; D006801:Humans; D015337:Multicenter Studies as Topic; D009369:Neoplasms / Q000601:surgery; D011183:Postoperative Complications / Q000191:economics* / Q000517:prevention & control; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D020246:Venous Thrombosis / Q000191:economics* / Q000517:prevention & control
D000925:Anticoagulants; D003871:Dermatan Sulfate; D006493:Heparin