PharmacoEconomics

, Volume 28, Issue 7, pp 521–538

Cost Effectiveness of Venous Thromboembolism Pharmacological Prophylaxis in Total Hip and Knee Replacement

A Systematic Review
  • Alok Kapoor
  • Warren Chuang
  • Nila Radhakrishnan
  • Kenneth J. Smith
  • Dan Berlowitz
  • Jodi B. Segal
  • Jeffrey N. Katz
  • Elena Losina
Review Article

DOI: 10.2165/11535210-000000000-00000

Cite this article as:
Kapoor, A., Chuang, W., Radhakrishnan, N. et al. Pharmacoeconomics (2010) 28: 521. doi:10.2165/11535210-000000000-00000

Abstract

Total hip and knee replacements (THR and TKR) are high-risk settings for venous thromboembolism (VTE). This review summarizes the cost effectiveness of VTE prophylaxis regimens for THR and TKR. We searched MEDLINE (January 1997 to October 2009), EMBASE (January 1997 to June 2009) and the UK NHS Economic Evaluation Database (1997 to October 2009).

We analysed recent cost-effectiveness studies examining five categories of comparisons: (i) anticoagulants (warfarin, low-molecular-weight heparin [LMWH] or fondaparinux) versus acetylsalicylic acid (aspirin); (ii) LMWH versus warfarin; (iii) fondaparinux versus LMWH; (iv) comparisons with new oral anticoagulants; and (v) extended-duration (≥3 weeks) versus shortduration (<3 weeks) prophylaxis. We abstracted information on cost and effectiveness for each prophylaxis regimen in order to calculate an incremental cost-effectiveness ratio. Because of variations in effectiveness units reported and horizon length analysed, we calculated two cost-effectiveness ratios, one for the number of symptomatic VTE events avoided at 90 days and the other for QALYs at the 1-year mark or beyond.

Our search identified 33 studies with 67 comparisons. After standardization, comparisons between LMWH and warfarin were inconclusive, whereas fondaparinux dominated LMWH in nearly every comparison. The latter results were derived from radiographic VTE rates. Extended-duration prophylaxis after THR was generally cost effective. Small numbers prohibit conclusions about aspirin, new oral anticoagulants or extended-duration prophylaxis after TKR.

Fondaparinux after both THR and TKR and extended-duration LMWH after THR appear to be cost-effective prophylaxis regimens. Small numbers for other comparisons and absence of trials reporting symptomatic endpoints prohibit comprehensive conclusions.

Supplementary material

40273_2012_28070521_MOESM1_ESM.pdf (125 kb)
Supplementary material, approximately 128 KB.
40273_2012_28070521_MOESM2_ESM.pdf (238 kb)
Supplementary material, approximately 243 KB.

Copyright information

© Adis Data Information BV 2010

Authors and Affiliations

  • Alok Kapoor
    • 1
  • Warren Chuang
    • 2
  • Nila Radhakrishnan
    • 1
  • Kenneth J. Smith
    • 3
  • Dan Berlowitz
    • 4
    • 5
  • Jodi B. Segal
    • 6
  • Jeffrey N. Katz
    • 7
  • Elena Losina
    • 8
    • 9
  1. 1.Hospital Medicine UnitBoston University School of MedicineBostonUSA
  2. 2.Hospitalist Medicine GroupMassachusetts General HospitalBostonUSA
  3. 3.Section of Decision Sciences and Clinical Systems ModellingUniversity of Pittsburgh School of MedicinePittsburghUSA
  4. 4.Center for Health Quality, Outcomes, and Economic ResearchEdith Nourse Rogers Memorial VA HospitalBedfordUSA
  5. 5.Boston University School of MedicineBostonUSA
  6. 6.Department of MedicineJohns Hopkins University School of MedicineBaltimoreUSA
  7. 7.Department of Orthopaedic Surgery and Division of Rheumatology, Immunology, and Allergy, and Orthopaedic and Arthritis Center for Outcomes ResearchBrigham and Women’s Hospital, Harvard Medical SchoolBostonUSA
  8. 8.Department of Orthopaedic Surgery, Brigham and Womens HospitalHarvard Medical SchoolBostonUSA
  9. 9.Department of BiostatisticsBoston University School of Public HealthBostonUSA

Personalised recommendations