Cost-effectiveness of LMWHs versus UFH for the prevention of postsurgical venous thromboembolism at orthopedic department in Clinical Hospital Stip

Biljana Lazarova,Aleksandra Kapedanovska Nestorovska,Zoran Sterjev,Ljubica Suturkova

doi:10.33320/maced.pharm.bull.2018.64.01.007

Biljana Lazarova, Aleksandra Kapedanovska Nestorovska + Show 2 more

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https://doi.org/10.33320/maced.pharm.bull.2018.64.01.007

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Abstract

This study aimed to evaluate the cost-effectiveness of thromboprophylaxis with LMWHs vs UFH in the prevention of venous thromboembolism (VTE) after orthopedic surgery from the perspective of the Clinical hospital in Stip. A model was developed that included both acute VTE (represented as a decision tree) and long-term complications (represented as a Markov process with one-year cycles). Transition probabilities were derived from phase III clinical trials comparing LMWHs with UFH and published literature. Unit costs were taken from the official, publically available hospital and health care insurance data and included direct drug costs for VTE (DVT and PE) prophylaxis (UFH/10000 IU and LMWHs/4000 IU) and hospitalization costs (hospital full board, disposables, medical services, concomitant therapy, healthcare professional time). Costs are reported in Macedonian Denars (MKD). When LMWHs and UFH are compared in orthopedic patients, LMWHs dominates UFH and are associated with improved health outcomes, measured by increased quality-adjusted life years (QALYs; 0.05) and with lower cost (savings of 20438.96 MKD) per patient. LMWHs are a cost-saving alternative to UFH for VTE prophylaxis in patients undergoing orthopedic surgery. Over a one-year horizon, LMWHs dominated UFH in the prevention of VTE events in patients undergoing surgery, providing more quality-of-life benefit at a lower cost. Keywords: anticoagulants, surgery, thrombosis

Highlights

Venous thromboembolism (VTE), which includes both deep vein thrombosis (DVT) and pulmonary embolism (PE), is a major burden on the health care system that caused surgeons to send an action call as early as 2008 (Anderson et al, 2007; Galson et al, 2008)
VTE is a serious threat to the health of patients which may persist for a long period following the patients discharge from a hospital
According to the results from cost-effectiveness analysis of low-molecularweight heparin (LMWH) versus unfractionated heparin (UFH), it can be concluded that LMWHs with respect to UHF is a cost-saving strategy for thromboprophylaxis in patients hospitalized at the orthopedic department

Summary

Introduction

Venous thromboembolism (VTE), which includes both deep vein thrombosis (DVT) and pulmonary embolism (PE), is a major burden on the health care system that caused surgeons to send an action call as early as 2008 (Anderson et al, 2007; Galson et al, 2008). The Health Care and Quality Research Agency stated that the provision of thromboprophylaxis is one of the most. The risk of VTE is high in patients who undergo major orthopedic surgical interventions, especially interventions for total hip or knee replacement. Suturkova due to perioperative activation of blood coagulation, the effects of surgical trauma of the femoral and iliac vein or embolism due to prolonged bed stay (Imberti et al, 2011)

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