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A cost-utility analysis of dabigatran, enoxaparin, and usual care for venous thromboprophylaxis after hip or knee replacement surgery in Thailand

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Abstract

To analyze the cost-utility of oral dabigatran etexilate, enoxaparin sodium injection, and no intervention for venous thromboembolism (VTE) prophylaxis after total hip or knee replacement (THR/TKR) surgery among Thai patients. A cost-utility analysis using a decision tree model was conducted using societal and healthcare payers’ perspectives to simulate relevant costs and health outcomes covering a 3-month time horizon. Costs were adjusted to year 2014. The willingness-to-pay threshold of THB 160,000 (USD 4926) was used. One-way sensitivity and probabilistic sensitivity analyses using a Monte Carlo simulation were performed. Compared with no VTE prophylaxis, dabigatran and enoxaparin after THR and TKR surgery incurred higher costs and increased quality adjusted life years (QALYs). However, their incremental cost-effectiveness ratios were high above the willingness to pay. Compared with enoxaparin, dabigatran for THR/TKR lowered VTE complications but increased bleeding cases; dabigatran was cost-saving by reducing the costs [by THB 3809.96 (USD 117.30) for THR] and producing more QALYs gained (by 0.00013 for THR). Dabigatran (vs. enoxaparin) had a 98 % likelihood of being cost effective. Dabigatran is cost-saving compared to enoxaparin for VTE prophylaxis after THR or TKR under the Thai context. However, both medications are not cost-effective compared to no thromboprophylaxis.

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Acknowledgments

This study is funded by Boehringer Ingelheim (Thai) Ltd. We would like to thank all stakeholders who shared their perspective in our meetings and Puttarin Kulchaitanaroaj, Ph.D., who assisted in editing the manuscript. SK, BC, and NC performed the research, NC and SK designed the research study, SK, BC and NC analyzed the data, and BC, NC, and SK wrote the manuscript. The authors have no competing interests.

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Authors and Affiliations

  1. School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, 46150, Bandar Sunway, Selangor, Malaysia

    Surachai Kotirum & Nathorn Chaiyakunapruk

  2. Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Center of Pharmaceutical Outcomes Research (CPOR), Naresuan University, Phitsanulok, Thailand

    Bunchai Chongmelaxme & Nathorn Chaiyakunapruk

  3. School of Pharmacy, University of Wisconsin, Madison, USA

    Nathorn Chaiyakunapruk

  4. School of Population Health, University of Queensland, Brisbane, Australia

    Nathorn Chaiyakunapruk

Authors
  1. Surachai Kotirum
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  2. Bunchai Chongmelaxme
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  3. Nathorn Chaiyakunapruk
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Correspondence to Nathorn Chaiyakunapruk.

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Kotirum, S., Chongmelaxme, B. & Chaiyakunapruk, N. A cost-utility analysis of dabigatran, enoxaparin, and usual care for venous thromboprophylaxis after hip or knee replacement surgery in Thailand. J Thromb Thrombolysis 43, 252–262 (2017). https://doi.org/10.1007/s11239-016-1433-5

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  • DOI: https://doi.org/10.1007/s11239-016-1433-5

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