Economic evaluation of the use of enoxaparin for thromboprophylaxis in acutely ill medical patients

Abstract

SUMMARYThe objective of this study was to assess the cost-effectiveness of prophylaxis for venous thromboembolism (VTE) in acutely ill medical patients using 40 mg enoxaparin od compared with unfractionated heparin (UFH) and placebo. An established decision tree model based on epidemiological data, clinical trials, and a recent meta-analysis was used to evaluate costs and consequences of alternative means of thromboprophylaxis in medical patients. Primary outcome measures were episodes of VTE (deep vein thrombosis or pulmonary embolism) and major bleeding. Secondary effectiveness measures included estimated mortality. In-hospital drug costs and administration time, in conjunction with long-term VTE complications up to 15 years and major bleeding, were considered. Results were estimated for a hypothetical cohort of 100 patients. The expected cost per 100 patients was £9,992 with enoxaparin 40 mg od, £9,972 with UFH 5000 IU bd and £8,781 with no prophylaxis. The expected number of episodes of VTE per 100 patients was 1.2 with enoxaparin 40 mg od, 1.4 with UFH 5000 IU bd and 3.2 with no prophylaxis. The expected number of episodes of major bleeding per 100 patients was 1.7 with enoxaparin 40 mg od, 3.5 with UFH 5000 IU bd and 1.1 with no prophylaxis. The cost-effectiveness ratios for enoxaparin compared to no prophylaxis were £796 per VTE event avoided (taking into account the small increase in bleeding). In acutely ill medical patients, enoxaparin 40 mg od was found to be cost-effective compared with no thromboprophylaxis. Compared to UFH prophylaxis, enoxaparin was found to be cost neutral.