Summary
Introduction
Pulmonary embolism, recurrent venous thromboembolism and post-thrombotic syndrome are major effects of deep vein thrombosis. As major orthopedic surgery for hip and knee is an important risk factor for these events, pharmacologic and/or physical prophylaxis is recommended. The study was designed to a) document methods of prophylaxis and estimate associated health care costs borne by the Italian National Health Service (NHS) and by patients who are administered the prophylaxis for hip/knee surgery; b) to detect possible determinants of interruption and/or switch of the therapy commenced during the hospital stay.
Study design
The study is observational and multi-centric. Patients were followed up for two months after discharge or until interruption of the prophylaxis. Data were purposely collected through specific questionnaires administered during patients’ hospitalisation, at each follow-up visit and at completion/interruption of the prophylaxis.
Results
125 patients were enrolled. About 2/3 of the sample were female while 60% were at least 70 years old; average age was 69. Most of the patients underwent hip surgery. Hospital prophylaxis averaged 11.9 days. Forty-one per cent of patients were administered nadroparin, while 40% were administered enoxaparin sodium. The remaining patients (19%) were administered dalteparin. For all treatments daily dosage was 0.4 ml. For most of patients specific training was provided on how to administrate and monitor the prophylaxis. After hospital discharge patients were either sent home (57.6%) or sent to a rehabilitation centre (42.4%). All patients remained on therapy; however, 10% changed therapy and another 3% prematurely ceased treatment. Mean stay on therapy after hospital discharge was 33 days. Total prophylaxis costs averaged 355 Euro. Fifty-six per cent of costs was for the drug, while 41% is attributable to the value of the time spent by professionals and caregivers to administer the treatment. Average daily cost per patient was 8 Euro (range: 2.7–14.3 Euro). Total cost high variability is mainly attributable to the duration of the prophylaxis which, in turn, is dependent on the setting of administration. In these patients, anti-thrombotic prophylaxis poses a relevant economic burden both to the NHS and to patients and their caregivers.
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La dott.ssa Elisa Martelli ha contribuito alla progettazione e conduzione dello studio quando era ricercatrice del CeRGAS.
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Fattore, G., Colangelo, I., Martelli, E. et al. Metodi e costi della profilassi della trombosi venosa profonda in chirurgia ortopedica in Italia. Pharmacoeconomics-Ital-Res-Articles 6, 69–80 (2004). https://doi.org/10.1007/BF03320625
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DOI: https://doi.org/10.1007/BF03320625