title: [Budgetary impact for the National Health System of apixaban prophylaxis of venous thromboembolism in patients undergoing total knee or hip replacement].
abstract: BACKGROUND
  Due to high health care costs of venous thromboembolism (VTE), economic analyses are needed to determine the efficiency of different drug treatments. Consequently, a study was conducted to estimate the budgetary impact for the National Health System (NHS) with apixaban for prevention of venous thromboembolism (VTE) in total hip (THR) or knee (TKR) replacement.
  
  
  METHODS
  Cost considered: the drugs for the prevention of VTE (apixaban, dabigatran, enoxaparin, fondaparinux, other heparins, rivaroxaban and warfarin) and the complications of VTE in the short term and in 5 years (deep vein thrombosis, pulmonary embolism, bleedings and the post-thrombotic syndrome). The effectiveness of prophylaxis was estimated using a meta-analysis. The VTE rates and death with apixaban are lower in THR and TKR than enoxaparin (-3.5% and -10.0%, respectively) with less bleeding events (-0.7% and -1.6%, respectively). Population data and unit costs were obtained from Spanish sources.
  
  
  METHODS
  5 years. All costs were discounted by 3.5% annually. Five years after commercialization, the use of apixaban was estimated to account for 23% of the prophylaxis of VTE and the use of enoxaparin decrease from the 60% to 33%.
  
  
  RESULTS
  Apixaban´s introduction for the prophylaxis of VTE would have a significant impact for the NHS, resulting in a saving of 547,422 Euro over a period of 5 years. In the case of outpatient administration of heparin did not have a cost, the savings for the NHS five years amount to 270,068 Euro.
  
  
  CONCLUSIONS
  According to this study, the introduction of apixaban may reduce the rate of VTE and bleeding compared with enoxaparin, decreasing the expenditure of NHS in VTE prophylaxis.
authors: Hospital Ruber Internacional, Madrid.
authors: Inmaculada
authors: I
authors: Gómez Arrayas
authors: Carmen
authors: C
authors: Suárez Fernández
authors: Jorge F
authors: JF
authors: Gómez Cerezo
authors: Lourdes
authors: L
authors: Betegón Nicolás
authors: Marina
authors: M
authors: de Salas-Cansado
authors: Carlos
authors: C
authors: Rubio-Terrés
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000191:economics / Q000627:therapeutic use; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D001562:Benzimidazoles / Q000191:economics / Q000627:therapeutic use; D002017:Budgets; D003363:Cost Control / Q000191:economics; D000069604:Dabigatran; D017984:Enoxaparin / Q000191:economics / Q000627:therapeutic use; D005260:Female; D005343:Fibrinolytic Agents / Q000191:economics / Q000627:therapeutic use*; D000077425:Fondaparinux; D006470:Hemorrhage / Q000188:drug therapy / Q000191:economics; D006801:Humans; D009025:Morpholines / Q000191:economics / Q000627:therapeutic use; D011134:Polysaccharides / Q000191:economics / Q000627:therapeutic use; D011655:Pulmonary Embolism / Q000188:drug therapy / Q000191:economics; D011720:Pyrazoles / Q000191:economics / Q000627:therapeutic use*; D011728:Pyridones / Q000191:economics / Q000627:therapeutic use*; D000069552:Rivaroxaban; D013030:Spain; D013222:State Medicine / Q000191:economics*; D013876:Thiophenes / Q000191:economics / Q000627:therapeutic use; D054556:Venous Thromboembolism / Q000209:etiology / Q000517:prevention & control*; D015091:beta-Alanine / Q000031:analogs & derivatives / Q000191:economics / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D001562:Benzimidazoles; D017984:Enoxaparin; D005343:Fibrinolytic Agents; D009025:Morpholines; D011134:Polysaccharides; D011720:Pyrazoles; D011728:Pyridones; D013876:Thiophenes; D015091:beta-Alanine; C522181:apixaban; D000069552:Rivaroxaban; D000069604:Dabigatran; D000077425:Fondaparinux