Pharmacoeconomic model of enoxaparin versus heparin for prevention of deep vein thrombosis after total hip replacement

Hawkins, David; Langley, Paul C; Krueger, Kem P.

doi:10.1093/ajhp/54.10.1185

Cited by 37 publications

(15 citation statements)

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“…All 39 studies were either decision analytic models based on individual randomized controlled trials [20-22,24,26,28,31-49,51-58] or meta-analysis [23,27,29,30,51]. …”

Section: Resultsmentioning

confidence: 99%

“…The studies were conducted from a North American or European economic perspective: 18 of the studies were conducted in the United States [26,29,31-41,45,48,51-53,55], six in the United Kingdom [21,23,25,46,57,58], four in Canada [23,28,34,51], and three in Italy [27,30,44], two in Sweden [42,47], and one each in Spain [43], Belgium [49], France [20], Norway [54], Switzerland [56], and Germany [24]. Seven studies were conducted from the perspective of the hospital [24,41,42,44,45,49,53], four from a societal perspective [20,28,30,32], nine from the perspective of another specific payer [23,31,33,40,54-58], and the remaining 19 studies did not clearly specify which perspective was used.…”

Section: Resultsmentioning

confidence: 99%

“…The prophylaxis time horizons considered were variable: either for 5 days [33,51]; 7 days [25,28,34,38,44,46-50,53-56]; 6 to 14 days [23]; 10 days [31,32,37,40,41,52], 8 to 12 days [43]; 7 to 14 days [26]; 6 to 14 days [57], 10 to 14 days [20,22-24,27,30,35,36,39,42-46]; 30 days [29], 8 to 33 days [59], and another for 8 weeks [45]. Twenty-five studies received some sponsorship by pharmaceutical companies [20,22-25,28,30,33-38,40,41,43,44,46,47,50,54-56,58].…”

Section: Resultsmentioning

confidence: 99%

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Economic analyses of venous thromboembolism prevention strategies in hospitalized patients: a systematic review

et al. 2012

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IntroductionDespite evidence-based guidelines for venous thromboembolism prevention, substantial variability is found in practice. Many economic evaluations of new drugs for thromboembolism prevention do not occur prospectively with efficacy studies and are sponsored by the manufacturers, raising the possibility of bias. We performed a systematic review of economic analyses of venous thromboembolism prevention in hospitalized patients to inform clinicians and policy makers about cost-effectiveness and the potential influence of sponsorship.MethodsWe searched MEDLINE, EMBASE, Cochrane Databases, ACP Journal Club, and Database of Abstracts of Reviews of Effects, from 1946 to September 2011. We extracted data on study characteristics, quality, costs, and efficacy.ResultsFrom 5,180 identified studies, 39 met eligibility and quality criteria. Each addressed pharmacologic prevention: low-molecular-weight heparins versus placebo (five), unfractionated heparin (12), warfarin (eight), one or another agents (five); fondaparinux versus enoxaparin (11); and rivaroxaban and dabigatran versus enoxaparin (two). Low-molecular-weight heparins were most economically attractive among most medical and surgical patients, whereas fondaparinux was favored for orthopedic patients. Fondaparinux was associated with increased bleeding events. Newer agents rivaroxaban and dabigatran may offer additional value. Of all economic evaluations, 64% were supported by manufacturers of a "new" agent. The new agent had a favorable outcome in 38 (97.4%) of 39 evaluations [95% confidence interval [CI] (86.5 to 99.9)]. Among studies supported by a pharmaceutical company, the sponsored medication was economically attractive in 24 (96.0%) of 25 [95% CI, 80.0 to 99.9)]. We could not detect a consistent bias in outcome based on sponsorship; however, only a minority of studies were unsponsored.ConclusionLow-molecular-weight heparins and fondaparinux are the most economically attractive drugs for venous thromboembolism prevention in hospitalized patients. Approximately two thirds of evaluations were supported by the manufacturer of the new agent; such drugs were likely to be reported as economically favorable.

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“…All 39 studies were either decision analytic models based on individual randomized controlled trials [20-22,24,26,28,31-49,51-58] or meta-analysis [23,27,29,30,51]. …”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Economic analyses of venous thromboembolism prevention strategies in hospitalized patients: a systematic review

et al. 2012

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“…Rates were modal values taken from the literature [3,12,[21][22][23][24][25][26][27][28][29][30][31][32][33][34]. The false-positive rates were assumed to be the same for both types of prophylaxis.…”

Section: False-positive Symptomatic Dvt and Pementioning

confidence: 99%

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

Lundkvist

Bergqvist

2007

Eur J Health Econ

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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.

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“…The LMWHs are also cost-effective with significant reduction of admissions and hospital stays as compared with traditional UH management. 15,16 Conclusions The favorable biologic characteristics, reduced need for laboratory monitoring, and the favorable results indicate that LMWHs have an important role in the management of acute DVT. However, LMWH preparations have different characteristics and different anti-Xa and anti-IIa activities.…”

mentioning

confidence: 99%

Is Low-Molecular-Weight Heparin the Answer for the Therapy of Acute Deep Vein Thrombosis?

Vouyouka¹,

Silver

1999

Vascular Surgery

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Pharmacoeconomic model of enoxaparin versus heparin for prevention of deep vein thrombosis after total hip replacement

Cited by 37 publications

References 0 publications

Economic analyses of venous thromboembolism prevention strategies in hospitalized patients: a systematic review

Economic analyses of venous thromboembolism prevention strategies in hospitalized patients: a systematic review

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

Is Low-Molecular-Weight Heparin the Answer for the Therapy of Acute Deep Vein Thrombosis?

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