Cost-Effectiveness of Prolonged Administration of a Low Molecular Weight Heparin for the Prevention of Deep Venous Thrombosis Following Total Hip Replacement

Bergqvist, David; Jönsson, Bengt

doi:10.1046/j.1524-4733.1999.24003.x

Cited by 40 publications

(26 citation statements)

References 17 publications

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“…This benefit was observed without any increase in bleeding complications. There is also good evidence, including health economic benefits, for extending thromboprophylaxis in orthopedic surgery patients undergoing THA [5,10,[18][19][20]. Bleeding was not measured in this study, partly due to methodological limitations in coding for bleeding.…”

Section: Discussionmentioning

confidence: 99%

Rates of symptomatic venous thromboembolism in US surgical patients: a retrospective administrative database study

Spyropoulos

Hussein

Lin

et al. 2009

J Thromb Thrombolysis

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US national performance measures may reduce the burden of venous thromboembolism (VTE) in surgical patients. To characterize the VTE rate in US surgical patients, and identify real-world independent VTE risk-factors, a national managed-care database was analyzed. 172,320 eligible surgical discharges (23.9% orthopedic, 76.1% abdominal surgery) from the PharMetrics database (January 2001-December 2005) were evaluated. The rate of thromboprophylaxis was low in orthopedic (40.5%) and abdominal (1.8%) surgery discharges, with the event rates of symptomatic VTE in these groups being 4.7% and 3.1%, respectively. The median time to VTE was 51 days: the majority of VTE events occurred post-discharge. Independent predictors of VTE included prior VTE (odds ratio [OR] 10.2; 95% CI: 9.2-11.4), and orthopedic versus abdominal surgery (OR 1.4; 95% CI: 1.4-1.6). Patients undergoing orthopedic or abdominal surgery remain at-risk for VTE. Implementation of national performance measures may help reduce the burden of VTE.

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Section: Discussionmentioning

confidence: 99%

Rates of symptomatic venous thromboembolism in US surgical patients: a retrospective administrative database study

Spyropoulos

Hussein

Lin

et al. 2009

J Thromb Thrombolysis

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“…Such papers seek to estimate costs, but are not based on real-practice costs or outcomes following VTE prophylaxis. LMWH also provides a clinical and economic alternative for high-risk patients who have suffered trauma or are at risk of VTE because of major orthopedic surgery [22][23][24][25][26][27]. Swedish studies of orthopedic surgery patients show that when costs of VTE prophylaxis with LMWH or UFH are considered, against the costs involved in surveillance testing and treatment for post-operative DVT, LMWH is cost effective for up to 30 days following surgery [24,25].…”

Section: Discussionmentioning

confidence: 99%

Hospital-based costs associated with venous thromboembolism prophylaxis regimens

Merli

Ferrufino

Lin

et al. 2009

J Thromb Thrombolysis

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Clinically and economically, venous thromboembolic (VTE) disease represents a significant burden to the US healthcare system. This analysis compares the total direct medical costs associated with VTE prophylaxis with enoxaparin and unfractionated heparin (UFH). Hospital discharge and billing records were extracted from the Premier Perspective database (January 2002-December 2006). The primary outcome was the total direct medical costs for discharges that were at risk of VTE and received enoxaparin or UFH. A total of 894,364 discharge records met the study inclusion criteria, of which 39.4% received enoxaparin and 60.6% received UFH. After adjustment for pre-defined covariates, mean total direct medical costs per discharge for the UFH group were $6,443, $1,080 more than those for the enoxaparin group ($5,363; P < .0001). In conclusion, enoxaparin prophylaxis is a cost-saving therapy, when compared with UFH, for the prevention of VTE in patients with a diverse range of medical conditions conferring VTE risk.

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“…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.…”

Section: Duration Of Treatmentmentioning

confidence: 95%

Venous thromboembolic prophylaxis for hip fractures

2010

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Patients with hip fractures are at very high risk for the development of venous thromboembolism (VTE). To provide an overview of cause, risk factors, current treatment strategies, and complications associated with VTE prophylaxis, we reviewed the most current, best available evidence on VTE prophylaxis for patients with hip fractures. We comprehensively reviewed the literature to assess the efficacy of VTE prophylaxis in patients with hip fractures, including the most recent published guidelines by national medical and surgical health organizations from the UK, USA, and Canada. Mechanical devices are effective in reducing the risk of VTE for hip fracture, but poor patient compliance is common and the devices are not recommended for sole VTE prophylaxis. Aspirin reduces the risk of VTE but does not provide optimal protection compared with other chemical agents; therefore, it is not recommended for sole VTE prophylaxis. Fondaparinux, warfarin, low-molecular-weight heparin, and unfractionated heparin reduce the risk of venographic deep vein thrombosis, but there is insufficient evidence that they reduce fatal pulmonary embolism or all-cause mortality. Fondaparinux is considered to be cost effective and more efficacious than low-molecular-weight heparin. At present, most major health organizations advocate at least 28 days of postoperative chemical prophylaxis. Chemical VTE prophylaxis should be administered to all patients with hip fractures unless contraindicated. Additional research is required to establish an agent that has a significant impact on fatal pulmonary embolism and all-cause mortality, without increasing bleeding complications, in this group of patients.

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Cost-Effectiveness of Prolonged Administration of a Low Molecular Weight Heparin for the Prevention of Deep Venous Thrombosis Following Total Hip Replacement

Cited by 40 publications

References 17 publications

Rates of symptomatic venous thromboembolism in US surgical patients: a retrospective administrative database study

Rates of symptomatic venous thromboembolism in US surgical patients: a retrospective administrative database study

Hospital-based costs associated with venous thromboembolism prophylaxis regimens

Venous thromboembolic prophylaxis for hip fractures

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