Cost-effectiveness of extended prophylaxis with fondaparinux compared with low molecular weight heparin against venous thromboembolism in patients undergoing hip fracture surgery

Abstract

A model was developed to estimate costs and clinical effectiveness of fondaparinux compared with enoxaparin after hip fracture surgery in Sweden. Outcomes and costs of venous thromboembolism (VTE)-related care from a health care perspective were incorporated, with symptomatic deep-vein thrombosis and pulmonary embolism, recurrent VTE, post-thrombotic syndrome, major haemorrhage and all-cause death being included. Event probabilities were derived from fondaparinux clinical trial data and published data. VTE-related resource use and associated costs as well as costs of prophylaxis were based on local Swedish data. Extended prophylaxis with fondaparinux could avoid an additional 28 symptomatic VTE per 1,000 patients compared with extended prophylaxis with enoxaparin in hip fracture surgery patients. Although the prophylaxis costs were higher in the fondaparinux group, these were offset by the lower costs associated with treating fewer VTE, which thus indicates that extended fondaparinux prophylaxis is the dominant alternative when compared with enoxaparin in hip fracture surgery.

Venous thromboembolic prophylaxis for hip fractures

“…1). Extended prophylaxis appears to be economically viable [78,79], and recent studies show fondaparinux to be more cost effective than enoxaparin [26,67,80]. To our knowledge, no studies show the cost effectiveness of aspirin.…”

“…The relative risk reduction for all VTE was 10.8%, but no difference was found for symptomatic DVT or nonfatal or fatal PE. SIGN and NICE guidelines recommend fondaparinux over LMWH as the optimal VTE prophylaxis for hip fracture based on better clinical efficacy [47], cost effectiveness [26,67], and a better side-effect profile, including a lower risk of HIT. NICE also advocates use of adjuvant mechanical prophylaxis [23].…”

“…However, great debate exists as to the optimal strategy in terms of the type and duration of treatment, especially with regards to the incidence of fatal PE and overall mortality [25]. The choice of anticoagulant may be influenced by cost, which is approximately 364-418 euros (492-563 US dollars) for 30 days' treatment with modern agents [26]. Other factors include clinical profile, individual physician choice [27], and local or national guidelines, which in turn are based on the current best evidence from randomized controlled trials.…”

Aplicación de los estudios de resultados de salud en el hospital

“…El mayor número de hemorragias mayores y del coste de adquisición del fármaco no compensa este ahorro obtenido de 924 € respecto a la enoxaparina, medicamento de referencia en nuestro medio. En otro estudio obtuvieron los mismos resultados pero la diferencia entre ambos tratamientos profilácticos fue menor, de 52,5 €, aunque la distribución de costes proporcionalmente fue muy similar a los obtenidos en nuestro trabajo para ambos grupos de pacientes tratados (Lundkvist et al, 2007).…”

“…En el estudio comparable al nuestro (Lundkvist et al, 2007) (Wade et al, 2004;Slof y Badia, 2006). Las diferencias también pueden ser atribuidas a la distinta situación geográfica o a la toma de diferentes años del valor de la moneda.…”