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Extended prophylaxis of venous thromboembolism with fondaparinux in patients undergoing major orthopaedic surgery in Italy: a cost-effectiveness analysis

Internal and Emergency Medicine volume 5, pages 33–40 (2010)Cite this article

Abstract

Enoxaparin is the most frequently used low-molecular weight heparin in the world, given in order to prevent venous thromboembolism (VTE) in patients undergoing major orthopaedic surgery (MOS). Fondaparinux is an effective and safe alternative. The aim of our study was to compare the cost-effectiveness of enoxaparin and fondaparinux in the extended thromboprophylaxis of patients undergoing MOS in Italy. A decision-tree model was developed: probabilities of symptomatic events were derived from the published trials; use of resources in Italy was evaluated by means of a questionnaire administered to a panel of experts. Only the direct costs of VTE (acute treatment of events and of complications) were considered. Cost units were derived from the current cost of drugs, and from the Italian National Healthcare tariffs in 2007. Incremental cost-effectiveness ratios were analysed at three time points: 30 days, 1 year and 5 years. The higher cost of fondaparinux was counterbalanced by reduced rates of early DVT, early PE and prophylaxis-related major bleeding. If compared with enoxaparin, after 30 days of extended prophylaxis, fondaparinux is associated with a savings of € 48.83 per patient; at the end of the first year, the savings increased to € 72.13, and after 5 years, the savings are € 74.36. One-way sensitivity analysis shows that the results are robust to the variation in unit costs for VTE-related care, or in event rates for both treatments. In conclusion, our model shows that, when administered for extended prophylaxis of VTE following MOS, fondaparinux is more effective and cost saving than enoxaparin.

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Acknowledgments

The authors would like to thank Francesco Bamfi, Andrea Pitrelli and Eduardo Stragliotto from Glaxo SmithKline SpA.

Conflict of interest statement

While this work was supported in part by a grant from a drug company sponsor that manufactures one of the drugs studied (Glaxo SmithKline SpA, Verona, Italy), it was unrestricted, and the authors had total control over reporting the outcome of their findings.

Author information

Affiliations

  1. Institute of Economics, Cattaneo-LIUC University, Castellanza, Italy

    Stefano Capri

  2. Department of Clinical Medicine, University of Insubria, Varese, Italy

    Walter Ageno

  3. Emergency Department, Thrombosis Center, Hospital of Piacenza, Piacenza, Italy

    Davide Imberti

  4. Department of Angiology and Blood Coagulation “Marino Golinelli”, University Hospital, Bologna, Italy

    Gualtiero Palareti

  5. Angiology and Thromboembolic Disease Unit, Fondazione IRCCS Policlinico “San Matteo”, Pavia, Italy

    Franco Piovella

  6. Azienda ULSS 9, Treviso, Italy

    Gianluigi Scannapieco

  7. Hemophilia and Thrombosis Center, IRCCS Fondazione Ospedale Maggiore Policlinico, Mangiagalli and Regina Elena, Via Pace, 9, 20122, Milan, Italy

    Marco Moia

Authors
  1. Stefano Capri
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  2. Walter Ageno
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  3. Davide Imberti
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  4. Gualtiero Palareti
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  5. Franco Piovella
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  6. Gianluigi Scannapieco
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  7. Marco Moia
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Corresponding author

Correspondence to Marco Moia.

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Capri, S., Ageno, W., Imberti, D. et al. Extended prophylaxis of venous thromboembolism with fondaparinux in patients undergoing major orthopaedic surgery in Italy: a cost-effectiveness analysis. Intern Emerg Med 5, 33–40 (2010). https://doi.org/10.1007/s11739-009-0324-6

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  • DOI: https://doi.org/10.1007/s11739-009-0324-6

Keywords

  • Enoxaparin
  • Pentasaccharide
  • Orthopaedic surgery
  • Venous thromboembolism
  • Prophylaxis
  • Cost-efficacy