The cost-effectiveness of fondaparinux compared with enoxaparin as prophylaxis against thromboembolism following major orthopedic surgery.
BACKGROUND
The selective antithrombotic fondaparinux is more effective than the low-molecular-weight heparin enoxaparin for prevention of venous thromboembolism (deep-vein thrombosis [DVT] or pulmonary embolism) in patients undergoing major orthopedic surgery, but its cost-effectiveness is undetermined.


OBJECTIVE
To evaluate the cost-effectiveness of fondaparinux relative to enoxaparin as prophylaxis against venous thromboembolism (VTE) for patients undergoing total hip replacement, total knee replacement or hip fracture surgery in the UK.


METHODS
A decision analysis model was created simulating the impact of fondaparinux and enoxaparin on patient outcomes and costs over various time points up to 5 years following surgery. The main outcome measures were treatment costs per patient and the incidence of clinical VTE and VTE-related deaths. A weighted (combined) cohort reflects the proportion of patients undergoing these procedures in 2000/2001.


RESULTS
In the combined cohort, compared with enoxaparin, fondaparinux is expected to produce 20 fewer clinical VTE events and 3.2 fewer VTE-related deaths per 1000 procedures at 5 years. Cost savings at 5 years are pound 27 per patient with fondaparinux (discounted at 6% per year). In each of the three surgical groups, fondaparinux leads to lower expected costs per patient and to a smaller number of VTE events and VTE-related deaths. RESULTS are sensitive to the price difference between fondaparinux and enoxaparin and variation in the rate of late DVT. The analysis is robust to variations in all other key parameters.


CONCLUSIONS
Compared with enoxaparin, fondaparinux is more effective and reduces costs to the healthcare system. At current prices, fondaparinux is the recommended strategy in the UK for prophylaxis following major orthopedic surgery.
Gordois
A
A
York Health Economics Consortium, University of York, York, UK. agordois@m-tag.net
Posnett
J
J
Borris
L
L
Bossuyt
P
P
Jönsson
B
B
Levy
E
E
de Pouvourville
G
G
D000925:Anticoagulants / Q000191:economics* / Q000627:therapeutic use; D019644:Arthroplasty, Replacement, Hip / Q000379:methods; D019645:Arthroplasty, Replacement, Knee / Q000379:methods; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D017984:Enoxaparin / Q000191:economics* / Q000627:therapeutic use; D000077425:Fondaparinux; D006620:Hip Fractures / Q000601:surgery; D006801:Humans; D008962:Models, Theoretical; D009985:Orthopedics / Q000191:economics* / Q000379:methods; D011134:Polysaccharides / Q000191:economics* / Q000627:therapeutic use; D012680:Sensitivity and Specificity; D013923:Thromboembolism / Q000517:prevention & control*; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000517:prevention & control
D000925:Anticoagulants; D017984:Enoxaparin; D011134:Polysaccharides; D000077425:Fondaparinux