Compliance of dutch orthopedic departments with national guidelines on thromboprophylaxis

Ettema, Harmen B.; Hoppener, Marnix R; Henny, C. P.; Büller, Harry R.; Verheyen, Cees C. P. M.

doi:10.1080/00016470510030409

Cited by 10 publications

(13 citation statements)

References 17 publications

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“…Notably, in addition to the advantages modeled, an oral administration route can be expected to result in further inpatient (as well as outpatient) cost-savings due to reduced nursing-time for administration of oral medication, and also the absence of risk for needle-stick injuries and sharps disposal. Furthermore, recent evidence might support limited adherence next to limited convenience with self-administration of LMWHs 12,13,15,35,36 . Observational studies among THR and TKR patients have shown that $35-40% of patients have problems with self-administration of subcutaneous prophylaxis, which ultimately leads to a situation where 7.5-37.5% of patients are completely or partially non-compliant, thereby reducing the effectiveness of VTE prophylaxis and posing risks for DVTs 12,13,15 .…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, recent evidence might support limited adherence next to limited convenience with self-administration of LMWHs 12,13,15,35,36 . Observational studies among THR and TKR patients have shown that $35-40% of patients have problems with self-administration of subcutaneous prophylaxis, which ultimately leads to a situation where 7.5-37.5% of patients are completely or partially non-compliant, thereby reducing the effectiveness of VTE prophylaxis and posing risks for DVTs 12,13,15 . The UK's National Institute for Health and Clinical Excellence (NICE) estimated the risk of developing DVT following orthopedic surgery in the absence of (effective) thromboprophylaxis to be as high as 44% for patients having THR and 27% for patients having TKR, highlighting the importance of compliance to anti-thrombotic therapy in general 36 .…”

Section: Discussionmentioning

confidence: 99%

“…In particular, on the involvement of homecare visits by a nurse to solve these problems, no hard data exist. Several studies indicate that such problems occur in 7.5-44% of the patients administering LMWHs or fondaparinux at home 9,10,[12][13][14][15] . This study was designed to quantify the potential administration problems with subcutaneous thromboprophylaxis by measuring the prevalence of such problems among patients that have undergone THR or TKR.…”

Section: I a L D I S T R I B U T I O N U N A U T H O R I Z E D U S mentioning

confidence: 99%

“…The therapeutic complexity related to the subcutaneous route of administration of anticoagulants may lead to reluctance of patients to self-administer in the home-setting following discharge from hospital or even it is impossible for them to do so. This may lead to inaccurate dosing, low therapy compliance, and, therefore, lower effectiveness of subcutaneous thromboprophylaxis to reduce the risk of VTE in daily practice [11][12][13][14][15] . Dabigatran etexilate (Pradaxa Õ , Boehringer Ingelheim, Ingelheim, Germany) is a novel oral direct thrombin inhibitor for prophylaxis of VTE for adult patients who have undergone elective THR or TKR surgery.…”

Section: I a L D I S T R I B U T I O N U N A U T H O R I Z E D U S mentioning

confidence: 99%

“…Based on an average hospital length of stay of 8 days for THR as well as for TKR 9,10 , total treatment periods were assumed to be 50 and 36 days for THR and TKR, respectively 24,25 . In probabilistic sensitivity analysis, symmetric triangular distributions were used (THR: minimum at 2 weeks, maximum at 10 weeks; TKR: minimum at 2 week, maximum at 6 weeks) 15 . Data on inpatient days and drug-utilization from July 2005-July 2006 were available for further analysis (source: PHARMO Utrecht, a specific report on the data is available on request).…”

Section: Dutch Population Datamentioning

confidence: 99%

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Economic evaluation of dabigatran etexilate for the primary prevention of venous tromboembolic events following major orthopedic surgery in the Netherlands

Postma

Kappelhoff

Hulst

et al. 2012

Journal of Medical Economics

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c i a l D i s t r i b u t i o n U n a u t h o r i z e d u s e p r o h i b i t e d . A u t h o r i s e d u s e r s c a n d o w n l o a d , d i s p l a y , v i e w a n d p r i n t a s i n g l e c o p y f o r p e r s o n a l u s eJournal of Medical Economics Vol. 15, No. 5, 2012, 878-886 Dabigatran etexilate is a new oral direct thrombin inhibitor for prophylaxis of venous thromboembolism (VTE) in patients who have elective surgery for total hip replacement (THR) or total knee replacement (TKR). Among the advantages of dabigatran etexilate over subcutaneous prophylaxis with Low Molecular Weight Heparin (LMWH) are reduced resource uses for (i) teaching patients to self-inject; (ii) home-care visits for subcutaneous administration; and (iii) absence of heparin-induced thrombocytopenia (HIT). Based on the demonstrated non-inferiority, the aim of this study was to conduct a cost-minimization analysis of oral dabigatran etexilate vs subcutaneous low-molecular weight heparin (LMWH) and fondaparinux from the Dutch healthcare perspective. Methods:A retrospective cohort study was conducted to measure resource use associated with subcutaneous prophylaxis. Results of this study were used in the model to elucidate specific advantages of dabigatran etexilate, next to reduced needs for self-inject teaching and lack of Heparin-Induced Thrombocytopenia. Drug and other resource utilization data were combined with local unit costs. Probabilistic sensitivity analysis was performed to account for uncertainty around relevant parameters included. Results:Home-care visits for subcutaneous administration problems were needed in 9.9% (95% CI ¼ 6.4-13.4) and 9.6% (95% CI ¼ 5.8-13.4) of THR and TKR patients, respectively. Based on costs for 1000 patients treated with dabigatran etexilate vs LMWHs, per patient cost-savings with dabigatran etexilate were estimated at E30.68 (95% CI ¼ 2.01-65.52) and E23.19 (95% CI ¼ 0.69-48.48) for THR and TKR, respectively. The probability that dabigatran etexilate would be cost-saving was estimated at 98.3% and 97.9% for THR and TKR, respectively. These cost-savings were even higher when including fondaparinux in the analysis, with per patient cost-savings of E69.87 (43.42-106.10) and E18.33 (1.63-41.26) for THR and TKR, respectively. Separate calculations for dabigatran etexilate vs nadroparin and dalteparin in THR resulted in probabilities of achieving cost-savings with dabigatran etexilate of 36.2% and 100%, respectively. For TKR these probabilities were estimated at 54.3% and 100%, respectively. Conclusions:Thromboprophylaxis with dabigatran etexilate is cost-saving in patients undergoing THR and TKR from the Dutch healthcare perspective, compared to subcutaneous LMWHs.878 Economic evaluation of dabigatran etexilate Postma et al.

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