title: Cost-effective prophylaxis against venous thromboembolism after total joint arthroplasty: warfarin versus aspirin.
abstract: Although recent guidelines suggest aspirin for venous thromboembolism (VTE) prophylaxis in low risk patients following total hip arthroplasty (THA) and total knee arthroplasty (TKA), there are no cost-effectiveness studies comparing aspirin and warfarin. In a Markov cohort cost-effectiveness analysis, we found that aspirin cost less and saved more quality-adjusted life-years (QALYs) than warfarin in all age groups. Cost per QALY gained by aspirin was $24,506.20 at age of 55 and $47,148.10 at the age of 85 following THA and $15,117.20 and $24,458.10 after TKA, which were greater than warfarin. In patients undergoing THA/TKA without prior VTE, aspirin is more cost-effective prophylactic agent than warfarin. Warfarin might be a better prophylaxis in TKA patients with high probability of VTE and very low probability of bleeding.
authors.affiliation: The Rothman Institute of Orthopaedics, Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Reza
authors.initials: R
authors.lastname: Mostafavi Tabatabaee
authors.affiliation: The Rothman Institute of Orthopaedics, Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Mohammad R
authors.initials: MR
authors.lastname: Rasouli
authors.affiliation: The Rothman Institute of Orthopaedics, Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Mitchell G
authors.initials: MG
authors.lastname: Maltenfort
authors.affiliation: The Rothman Institute of Orthopaedics, Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Javad
authors.initials: J
authors.lastname: Parvizi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D001241:Aspirin / Q000627:therapeutic use*; D018890:Chemoprevention / Q000191:economics; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D019057:Quality-Adjusted Life Years; D054556:Venous Thromboembolism / Q000191:economics / Q000209:etiology / Q000517:prevention & control*; D014859:Warfarin / Q000627:therapeutic use*
chemical_list: D000925:Anticoagulants; D014859:Warfarin; D001241:Aspirin
keywords: aspirin; cost-effectiveness analysis; total joint arthroplasty; venous thromboembolism; warafarin