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A Caprini Risk Score-Based Cost-Effectiveness Analysis of Enoxaparin for the Thromboprophylaxis of Patients After Nonorthopedic Surgery in a Chinese Healthcare Setting

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Abstract

Background

Venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE), is an important cause of post-surgery morbidity and mortality. However, it is unclear whether thromboprophylaxis with the low-molecular-weight heparin (LMWH) enoxaparin after non-orthopedic surgery could balance the cost and clinical outcomes or not.

Objectives

The purpose of this research was to evaluate the cost-effectiveness of enoxaparin for the universal prophylaxis of VTE and associated long-term complications in patients after non-orthopedic surgery compared with no prevention in a Chinese healthcare setting.

Methods

A decision model, which included both acute VTE and long-term complications, was developed to assess the economic outcomes of the two strategies for patients after non-orthopedic surgery. Quality-adjusted life years (QALYs) and direct medical costs were measured over a 5-year horizon. Incremental cost-effectiveness ratios (ICERs) were calculated.

Results

Compared with no prevention, patients under enoxaparin treatment with Caprini risk scores of 3–4, 5–6, 7–8, and ≥ 9 increased by 0.012, 0.017, 0.034, and 0.102 in QALYs, respectively. The results were either that ICERs of thromboprophylaxis with enoxaparin over no prevention were lower than the thresholds or that thromboprophylaxis with enoxaparin was dominant. For patients with a Caprini risk score ≥ 9, thromboprophylaxis with enoxaparin is dominant across the whole drug use duration range. The sensitivity analysis confirmed the results.

Conclusions

As the first analysis evaluating the economic outcomes of enoxaparin in patients undergoing general non-orthopedic surgery, this study suggests that thromboprophylaxis with enoxaparin is highly cost-effective compared with no prevention in patients with Caprini risk score ≥ 3.

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Authors and Affiliations

  1. Department of Pharmacy, Gansu Provincial Hospital, Gansu, China

    Yun Bao

  2. Department of General Surgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China

    Gang Zhao

  3. RWE Solution and HEOR, Quintiles IMS, Shanghai, China

    Shuli Qu & Tengbin Xiong

  4. HEOR, Sanofi China, Shanghai, China

    Xingxing Yao

  5. Medical Decision and Economic Group, Department of Pharmacy, Ren Ji Hospital, South Campus, School of Medicine, Shanghai Jiao Tong University, Shanghai, China

    Bin Wu

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  1. Yun Bao
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  2. Gang Zhao
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  3. Shuli Qu
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Corresponding author

Correspondence to Bin Wu.

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Funding

This study was funded by Sanofi China. The authors are fully responsible for all content and editorial decisions. They did not receive financial support or other forms of compensation related to the development of the article. All of the authors contributed significantly to the data collection and analysis, as well as to manuscript review and editing. They all agreed on its content and on submission for publication.

Conflict of interest

Xingxing Yao is an employee of Sanofi China. Shuli Qu and Tengbin Xiong are employees of QuintilesIMS China, which received a research fund from Sanofi China. None of the remaining authors have any personal or financial conflicts of interest.

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Bao, Y., Zhao, G., Qu, S. et al. A Caprini Risk Score-Based Cost-Effectiveness Analysis of Enoxaparin for the Thromboprophylaxis of Patients After Nonorthopedic Surgery in a Chinese Healthcare Setting. Clin Drug Investig 40, 161–171 (2020). https://doi.org/10.1007/s40261-019-00876-4

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  • DOI: https://doi.org/10.1007/s40261-019-00876-4

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