[Economic analysis of dalteparin use in knee surgery at Instituto Mexicano del Seguro Social].
BACKGROUND
Knee surgery is a risk factor for thromboembolic disease. Prophylaxis reduces the risk of this condition.


METHODS
Economic and health consequences of drugs preventing and treating thromboembolic disease in patients undergoing knee surgery from the institutional perspective (time horizon: 1 year) were estimated. The measures of effectiveness were: reduction in the number of cases (per 1,000 patients) of deep vein thrombosis, pulmonary embolism, hospital admissions and deaths. Transition probabilities were estimated by meta-analysis. The alternatives were: warfarin (reference), dalteparin, enoxaparin, nadroparin, unfractionated heparin + warfarin, and non-prophylaxis. Data on resources use and costs corresponds to the Instituto Mexicano del Seguro Social (IMSS). Acceptability curves were constructed.


RESULTS
No prophylaxis implied three times higher cost ($18,835.10 versus $5,967.10) and less effectiveness in comparison with warfarin. The incremental cost-effectiveness ratios for enoxaparin were $3, $13, $17 and $3 per each additional case of deep vein thrombosis, pulmonary embolism, death and hospital admission avoided. Results of nadroparin and unfractionated heparin were inferior to warfarin (59.1% and 72.9% more costly and less effective in three measures of effectiveness, respectively). Dalteparin showed higher health outcomes and lower cost compared with warfarin (-20.6%). Dalteparin had a higher probability of being cost-effective than enoxaparin.


CONCLUSIONS
thromboprophylaxis is a clinically and economically favorable alternative. The identification of a pharmacoeconomic profile of alternatives to perform it becomes relevant given the increasing pressure on institutional budgets.


CONCLUSIONS
Dalteparin would be a cost-saving alternative in thromboprophylaxis of patients undergoing knee surgery at IMSS.
Programa Competitividad y Salud, Fundación Mexicana para la Salud, Mexico.
Héctor
H
Arreola-Ornelas
Alfonso
A
Rosado-Buzzo
Lourdes
L
García-Mollinedo
Javier
J
Dorantes Aguilar
Emilio
E
Muciño-Ortega
Joaquín Federico
JF
Mould-Quevedo
D000047:Academies and Institutes / Q000191:economics; D000925:Anticoagulants / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use; D019645:Arthroplasty, Replacement, Knee / Q000191:economics* / Q000706:statistics & numerical data; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D017985:Dalteparin / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use; D003952:Diagnostic Imaging / Q000191:economics; D016527:Drug Costs; D006493:Heparin / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D008390:Markov Chains; D008800:Mexico; D011183:Postoperative Complications / Q000191:economics / Q000209:etiology / Q000517:prevention & control*; D019106:Postoperative Hemorrhage / Q000139:chemically induced; D011655:Pulmonary Embolism / Q000191:economics / Q000209:etiology / Q000517:prevention & control; D012189:Retrospective Studies; D012943:Social Security / Q000191:economics; D019851:Thrombophilia / Q000188:drug therapy* / Q000191:economics / Q000209:etiology / Q000517:prevention & control; D020246:Venous Thrombosis / Q000191:economics / Q000209:etiology / Q000517:prevention & control; D014859:Warfarin / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use
D000925:Anticoagulants; D014859:Warfarin; D006493:Heparin; D017985:Dalteparin