Economic evaluation of enoxaparin as postdischarge prophylaxis for deep vein thrombosis (DVT) in elective hip surgery.
OBJECTIVE
Clinical trials indicate enoxaparin thromboprophylaxis (Clexane) can be effective and safe when used in an outpatient setting and that extending the length of thromboprophylaxis with enoxaparin to the postdischarge period may be more effective than inpatient thromboprophylaxis alone. This may increase the cost of thromboprophylaxis. The objective of the study was to estimate the expected cost-effectiveness of using enoxaparin for hospital admission only vs. enoxaparin for hospital admission and for 21 days postdischarge.


METHODS
Decision analysis was used to combine probability, resource use and unit cost data, using the framework of cost-effectiveness analysis. The model used a societal perspective to estimate the expected costs of treatment and outcomes to patients undergoing orthopedic surgery for elective hip replacement. Incremental cost-effectiveness ratios were calculated to provide estimates of the cost per life gained, cost per year life year gained and cost per quality-adjusted life year gained with extended use of enoxaparin thromboprophylaxis.


RESULTS
There was an expected cost per quality-adjusted life year gained of pounds 5732 associated with extended enoxaparin thromboprophylaxis. The results were sensitive to the percentage of patients who could administer enoxaparin injections at home, the rate of DVT associated with standard enoxaparin thromboprophylaxis and the rate of PE associated with standard and extended enoxaparin thromboprophylaxis.


CONCLUSIONS
The analyses indicated that in most cases extended enoxaparin thromboprophylaxis resulted in increased costs for health care services. In all cases, extended thromboprophylaxis with enoxaparin was associated with improved survival and life-years gained.
Davies
L M
LM
School of Psychiatry and Behavioural Sciences, University of Manchester, Manchester M13 9WL, United Kingdom. Linda.Davies@man.ac.uk
Richardson
G A
GA
Cohen
A T
AT