Abstract
Venous thromboembolism (VTE) commonly occurs in patients undergoing orthopedic procedures such as total hip or knee replacement, or major abdominal surgery. Unfractionated heparin (UFH) and Enoxaparin (LMWHs) are the treatments of choice for VTE prevention post-surgery in Egypt. The purpose of this study was to assess the cost-effectiveness of enoxaparin compared to UFH in short term- and extended prophylaxis with enoxaparin in patients undergoing major surgery in Egypt. The Cost-effectiveness of enoxaparin versus UFH was assessed using a decision tree, modeling the probability of experiencing VTE-related events post major surgery while considering both costs and disutilities. Estimates of resources utilization and costs were collected from an expert panel, while disutilities from published sources. The evaluation was based on two clinical trials; ENOXACAN-I and ENOXACAN-II. A Health care payer perspective was considered. The analysis was conducted with a 6-months’ time horizon and as such, discounting was not considered. A one-way sensitivity analysis (OWSA) and probabilistic sensitivity analysis (PSA) were performed. When comparing enoxaparin to UFH for short term prophylaxis, the results demonstrate an increase in QALY of 0.0009 and a cost decrease of EGP244, mainly due to the significant difference in rate of DVT in favor of enoxaparin. Thus, enoxaparin was dominant compared to UFH. The analysis comparing enoxaparin short term- versus extended prophylaxis resulted in an increase in QALY of 0.0146 and an increase in costs of EGP 72, resulting in an ICER of EGP4,951/QALY which is within the willingness-to-pay (WTP) threshold of EGP80,200/QALY. OWSA and PSA showed the robustness of the results. This analysis clearly demonstrates the cost effectiveness of enoxaparin compared to UFH in both short term and extended prophylaxis of VTE in patients undergoing major surgery in Egypt.
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