title: A cost-utility analysis of dabigatran, enoxaparin, and usual care for venous thromboprophylaxis after hip or knee replacement surgery in Thailand.
abstract: To analyze the cost-utility of oral dabigatran etexilate, enoxaparin sodium injection, and no intervention for venous thromboembolism (VTE) prophylaxis after total hip or knee replacement (THR/TKR) surgery among Thai patients. A cost-utility analysis using a decision tree model was conducted using societal and healthcare payers' perspectives to simulate relevant costs and health outcomes covering a 3-month time horizon. Costs were adjusted to year 2014. The willingness-to-pay threshold of THB 160,000 (USD 4926) was used. One-way sensitivity and probabilistic sensitivity analyses using a Monte Carlo simulation were performed. Compared with no VTE prophylaxis, dabigatran and enoxaparin after THR and TKR surgery incurred higher costs and increased quality adjusted life years (QALYs). However, their incremental cost-effectiveness ratios were high above the willingness to pay. Compared with enoxaparin, dabigatran for THR/TKR lowered VTE complications but increased bleeding cases; dabigatran was cost-saving by reducing the costs [by THB 3809.96 (USD 117.30) for THR] and producing more QALYs gained (by 0.00013 for THR). Dabigatran (vs. enoxaparin) had a 98 % likelihood of being cost effective. Dabigatran is cost-saving compared to enoxaparin for VTE prophylaxis after THR or TKR under the Thai context. However, both medications are not cost-effective compared to no thromboprophylaxis.
authors.affiliation: School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, 46150, Bandar Sunway, Selangor, Malaysia.
authors.forename: Surachai
authors.initials: S
authors.lastname: Kotirum
authors.affiliation: Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Center of Pharmaceutical Outcomes Research (CPOR), Naresuan University, Phitsanulok, Thailand.
authors.forename: Bunchai
authors.initials: B
authors.lastname: Chongmelaxme
authors.affiliation: School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, 46150, Bandar Sunway, Selangor, Malaysia. nathorn.chaiyakunapruk@monash.edu.|Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Center of Pharmaceutical Outcomes Research (CPOR), Naresuan University, Phitsanulok, Thailand. nathorn.chaiyakunapruk@monash.edu.|School of Pharmacy, University of Wisconsin, Madison, USA. nathorn.chaiyakunapruk@monash.edu.|School of Population Health, University of Queensland, Brisbane, Australia. nathorn.chaiyakunapruk@monash.edu.
authors.forename: Nathorn
authors.initials: N
authors.lastname: Chaiyakunapruk
mesh_terms: D019644:Arthroplasty, Replacement, Hip / Q000191:economics; D019645:Arthroplasty, Replacement, Knee / Q000191:economics; D003362:Cost-Benefit Analysis / Q000379:methods*; D000069604:Dabigatran / Q000191:economics / Q000627:therapeutic use*; D003663:Decision Trees; D017984:Enoxaparin / Q000191:economics / Q000627:therapeutic use*; D017048:Health Care Costs; D006801:Humans; D009010:Monte Carlo Method; D011183:Postoperative Complications / Q000188:drug therapy / Q000191:economics / Q000517:prevention & control; D011292:Premedication / Q000191:economics; D019057:Quality-Adjusted Life Years; D013785:Thailand; D054556:Venous Thromboembolism / Q000191:economics / Q000517:prevention & control*
chemical_list: D017984:Enoxaparin; D000069604:Dabigatran
keywords: Cost-utility analysis; Dabigatran; Enoxaparin; Prophylaxis; Thailand; Venous thromboembolism