title: Prolonged postoperative venous thrombo-embolism prophylaxis is cost-effective in advanced ovarian cancer patients.
abstract: OBJECTIVE
  The purpose of this study was to investigate the cost-effectiveness of prolonged prophylaxis with enoxaparin in high-risk surgical patients with ovarian cancer. In addition, we sought to quantify the impact of prolonged prophylaxis (PP) on the incidence of venous thromboembolism (VTE), its related complications, and overall patient survival.
  
  
  METHODS
  A Markov decision analytic model was used to estimate the costs, resource allocation and outcomes associated with the prolonged use of enoxaparin, for a total of four weeks after surgery, in patients undergoing primary debulking surgery for stage IIIC ovarian cancer. We estimated incremental cost per quality-adjusted life-year (QALY) at one and five year intervals; the estimated reduction in VTE episodes, bleeding episodes, and survival at the five year interval for a simulated cohort of 10,000 women.
  
  
  RESULTS
  The incremental cost effectiveness ratio (ICER) for prolonged prophylaxis (PP) was $5236/QALY and $-1462/QALY at one and five years respectively. For patients receiving PP, the model estimated a 12% reduction in the clinically evident VTE episodes and a higher five-year survival (31.61% vs. 29.96%; p<0.0001). Resource allocation analysis reveals that 95% of initial investment cost of prolonged enoxaparin is recovered within one year.
  
  
  CONCLUSIONS
  In ovarian cancer patients undergoing open abdominal surgery, prolonged VTE prophylaxis not only improves patient outcomes, but is also a cost saving strategy when modeled over five years. A significant reduction in the episodes of VTE and a higher overall survival warrants consideration for the routine use of PP in this patient population.
authors.affiliation: Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Wisconsin, Madison, USA. emailuppal@gmail.com
authors.forename: Shitanshu
authors.initials: S
authors.lastname: Uppal
authors.forename: Enrique
authors.initials: E
authors.lastname: Hernandez
authors.forename: Moushumi
authors.initials: M
authors.lastname: Dutta
authors.forename: Vani
authors.initials: V
authors.lastname: Dandolu
authors.forename: Stephen
authors.initials: S
authors.lastname: Rose
authors.forename: Ellen
authors.initials: E
authors.lastname: Hartenbach
mesh_terms: D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis; D017984:Enoxaparin / Q000008:administration & dosage* / Q000191:economics* / Q000494:pharmacology / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008390:Markov Chains; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D011336:Probability; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D020246:Venous Thrombosis / Q000453:epidemiology / Q000517:prevention & control*
chemical_list: D017984:Enoxaparin