Cost/death averted with venous thromboembolism prophylaxis in patients undergoing total knee replacement or knee arthroplasty.
OBJECTIVE
To compare the cost-effectiveness of warfarin or enoxaparin with no prophylaxis for prevention of venous thromboembolism in patients undergoing total knee replacement (TKR) or knee arthroplasty.


METHODS
Literature search and retrospective database analysis.


METHODS
Cohort of 42,692 patients over 40 years old who underwent TKR or knee arthroplasty, with a subsequent length of stay of at least 1 day, and who did not die postoperatively.


RESULTS
Both warfarin and enoxaparin were superior to no prophylaxis with regard to costs and clinical outcomes. Enoxaparin was associated with medical charges of $26,455/patient and prevented 194 deaths/10,000 patients. Warfarin was associated with medical charges of $27,360/patient and prevented 124 deaths/10,000 patients.


CONCLUSIONS
A wide range of model estimates and assumptions identify enoxaparin as the prophylaxis modality of choice for preventing venous thromboembolism and subsequent clinical complications following total knee replacement surgery.
Nerurkar
Jayanti
J
Department of Pharmaceutical and Biomedical Sciences, College of Pharmacy, University of Georgia, Athens 30602, USA.
Wade
William E
WE
Martin
Bradley C
BC
D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use*; D019645:Arthroplasty, Replacement, Knee; D003362:Cost-Benefit Analysis; D017984:Enoxaparin / Q000627:therapeutic use; D017048:Health Care Costs; D006801:Humans; D016239:MEDLINE; D011183:Postoperative Complications; D011292:Premedication; D013923:Thromboembolism / Q000191:economics / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D014859:Warfarin / Q000627:therapeutic use
D000925:Anticoagulants; D017984:Enoxaparin; D014859:Warfarin