title: Cost-Effectiveness of Different Strategies for the Prevention of Venous Thromboembolism After Total Hip Replacement in China.
abstract: The aim of this study was to evaluate the cost-effectiveness of rivaroxaban and apixaban versus enoxaparin for the universal prophylaxis of venous thromboembolism (VTE) and associated long-term complications in Chinese patients after total hip replacement (THR).
  
  
  
  A decision model, which included both acute VTE (represented as a decision tree) and the long-term complications of VTE (represented as a Markov model), was developed to assess the economic outcomes of the three prophylactic strategies for Chinese patients after THR. Transition probabilities for acute VTE were derived from two randomized controlled studies, RECORD1 and ADVANCE3, of patients after THR. The transition probabilities of long-term complications after acute VTE, utilities, and costs were derived from the published literature and local healthcare settings. One-way and probabilistic sensitivity analyses (PSA) were performed to test the uncertainty concerning the model parameters. The quality-adjusted life years (QALYs) and direct medical costs were reported over a 5-year horizon, and incremental cost-effectiveness ratios (ICERs) were also calculated.
  
  
  
  Thromboprophylaxis with apixaban was estimated to have a higher cost (US $178.70) and more health benefits (0.0025 QALY) than thromboprophylaxis with enoxaparin over a 5-year time horizon, which resulted in an ICER of US $71,244 per QALY gained and was more than three times the GDP per capita of China in 2014 (US $22,140). Owing to the higher cost and lower generated QALYs, rivaroxaban was inferior to enoxaparin among post-THR patients. The sensitivity analyses confirmed these results.
  
  
  
  The analysis found that apixaban was not cost-effective and that rivaroxaban was inferior to enoxaparin. This finding indicates that compared with enoxaparin, the use of apixaban for VTE prophylaxis after THR does not represent a good value for the cost at the acceptable threshold in China; in addition, the cost of rivaroxaban was higher with lower QALYs.
authors.affiliation: Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Yishang Road 600, Shanghai, China.
authors.forename: Xiaoyu
authors.initials: X
authors.lastname: Yan
authors.affiliation: Department of Respiratory Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Yishang Road 600, Shanghai, China.
authors.forename: Xiaohua
authors.initials: X
authors.lastname: Gu
authors.affiliation: Department of Cardiology, Renji Hospital, South Campus, School of Medicine, Shanghai Jiaotong University, Shanghai, China.
authors.forename: Zhenxing
authors.initials: Z
authors.lastname: Xu
authors.affiliation: Medical Decision and Economic Group, Department of Pharmacy, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Jiangyue Road 2000, Shanghai, China.
authors.forename: Houweng
authors.initials: H
authors.lastname: Lin
authors.affiliation: Medical Decision and Economic Group, Department of Pharmacy, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Jiangyue Road 2000, Shanghai, China. wbwithtg@hotmail.com.
authors.forename: Bin
authors.initials: B
authors.lastname: Wu
mesh_terms: D000925:Anticoagulants / Q000191:economics / Q000627:therapeutic use; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D002681:China; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D017984:Enoxaparin / Q000191:economics / Q000627:therapeutic use; D006801:Humans; D000069451:Long Term Adverse Effects / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D011183:Postoperative Complications / Q000517:prevention & control*; D011720:Pyrazoles / Q000191:economics / Q000627:therapeutic use; D011728:Pyridones / Q000191:economics / Q000627:therapeutic use; D019057:Quality-Adjusted Life Years; D016032:Randomized Controlled Trials as Topic; D000069552:Rivaroxaban / Q000191:economics / Q000627:therapeutic use; D054556:Venous Thromboembolism / Q000209:etiology / Q000517:prevention & control
chemical_list: D000925:Anticoagulants; D017984:Enoxaparin; D011720:Pyrazoles; D011728:Pyridones; C522181:apixaban; D000069552:Rivaroxaban
keywords: Anticoagulation; Cardiology; Cost-effectiveness analysis; Venous thromboembolism