Economic evaluation of enoxaparin vs. placebo for the prevention of venous thromboembolism in acutely ill medical patients.
OBJECTIVE
This paper presents an economic evaluation of a strategy of thromboprophylaxis in acutely ill medical patients with enoxaparin 40 mg vs. no intervention in the context of the French Health System.


METHODS
The evaluation used a decision-analysis model to simulate the results of a hypothetical naturalistic, long-term study reflecting the usual care pattern for the patients. The short-term outcomes were derived from an international, double-blind, placebo-controlled randomized clinical study performed in 1102 patients older than 40 years. Treatment was scheduled to last 10 +/- 4 days and primary outcome was venous thromboembolism events rates between days 1 and 14 assessed clinically or through systematic contrast venography.


RESULTS
For an hypothetical cohort of 1000 hospitalized medical patients, the model suggested that the prophylaxis strategy would avoid between 1 and 10 deaths (median 4) and between 60 and 127 cases of venous thromboembolism events (median 94). By including or not the costs associated with long-term complications (post-phlebitis syndrome), the net extra cost per patient was estimated as a net saving or 35,857 Euros (Euro), respectively. The corresponding cost-effectiveness ratios in terms of cost per avoided death were a net saving or Euro 8102 (median value), respectively.


CONCLUSIONS
Thromboprophylaxis with enoxaparin in hospitalized acutely ill patients over 40 years of age appears to be an efficient strategy using French cost data.
Pechevis
M
M
CEMKA (Consultancy in Health Economics), Bourg-la-Reine, France.
Detournay
B
B
Pribil
C
C
Fagnani
F
F
Chalanson
G
G