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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References
Ageno W, Squizzato A, Garcia D, Imberti D (2006) Epidemiology and risk factors of venous thromboembolism. Semin Thromb Hemost 32:651–658
Hirsh J, Guyatt G, Albere GW, Harrington R, Shunemann HJ (2008) Antithrombotic and thrombolytic therapy: American College of Chest Physicians evidence-based clinical practice guidelines (8th edition). Chest 133(6 Suppl):110S–112S
Lassen MR, Bauer KA, Erksson BI et al (2002) Postoperative fondaparinux versus preoperative enoxaparin for prevention of venous thromboembolism in elective hip-replacement surgery: a randomised double-blind comparison (Ephesus Study). Lancet 359:1715–1720
Bauer KA, Eriksson BI, Lassen MR et al (2001) Fondaparinux compared with enoxaparin for the prevention of venous thromboembolism after elective major knee surgery. N Engl J Med 345:1305–1310
Eriksson BI, Bauer KA, Lassen MR et al (2001) Fondaparinux compared with enoxaparin for the prevention of venous thromboembolism after hip fracture surgery. N Engl J Med 345:1298–1304
Turpie AG, Bauer KA, Eriksson BI et al (2002) Postoperative fondaparinux versus postoperative enoxaparin for prevention of venous thromboembolism in elective hip-replacement surgery: a randomised double-blind comparison (Pentathlon 2000 Study). Lancet 359:1721–1726
Turpie AG, Bauer K, Eriksonn BI, Lassen MR (2002) Fondaparinux vs enoxaprin for the prevention of venous thromboembolism in major orthopaedic surgery. A meta-analysis of 4 randomized double-blind studies. Arch Intern Med 162:1833–1840
Eriksson BI, Lassen MR (2003) Duration of prophylaxis against venous thromboembolism with fondaparinux after hip fracture surgery: a multicenter, randomized, placebo-controlled, double-blind study. Arch Intern Med 163:1337–1342
Gordois A, Posnett J, Borris L, Bossuyt P, Jonsson B, Levy E, De Pouvourille G (2003) The cost-effectiveness of fondaparinux compared with enoxaparin as prophylaxis against thromboembolism following MOS. J Thromb Haemost 1:2167–2174
Szucs TD, Kaiser WE, Mahler F, Gutzwiller F (2005) Thromboembolic prophylaxis with fondaparinux in orthopaedic surgery: outcomes and costs. Hearth Drug 5:121–130
Lundkvist J, Bergqvist D, Jonsson B (2003) Cost-effectiveness of fondaparinux vs enoxaparin as venous thromboembolism prophylaxis in Sweden. Eur J Health Econ 4:254–262
Lundkvist J, Bergqvist D, Jonsson B (2007) Cost-effectiveness of extended prophylaxis with fondaprinux compared to low molecular weight heparin against venous thromboembolism in patients undergoing hip fracture surgery. Eur J Health Econ 8:313–323 [Epub 2007 Jan 16]
Bjorvatn A, Kristiansen F (2005) Fondaparinux sodium compared with enoxaprin sodium: a cost-effectiveness analysis. An J Cardiovasc Drugs 5:121–130
Sullivan SD, Bruce L, Davidson BL, Kahn SR, Muntz JF, Oster G, Raskob G (2004) A cost-effectiveness analysis of fondaparinux sodium vs enoxaparin sodium as prophylaxis against venous thromboembolism. Pharmacoeconomics 22:605–620
Sullivan SD, Kwong L, Nutescu E (2006) Cost-effectiveness of fondaprinux compared with enoxaparin as prophylaxis against venous thromboembolism in patients undergoing hip fracture surgery. Value in health 9(2):68–76
Spruill WJ, William EW, Ryan BL (2004) A cost analysis of fondaparinux vs enoxaparin in total knee arthroplasty. Am J Ther 11:3–8
Dranitsaris G, Kahn SR, Stumpo C, Paton TW, Martineau J, Smith R, Ginsebrg JS (2004) Pharmacoeconomic analysis of fondaparinux vs enoxaparin for the prevention of thromboembolic events in orthopaedic surgery patients. Am Cardiovasc Drugs 4:325–333
Agnelli G, Verso M, Ageno W, Imberti D, Moia M, Palareti G, Rossi G, Pistelli R (2008) The MASTER registry on venous thromboembolism: description of the study cohort. Thromb Res 121:605–610 [Epub 2007 Aug 10]
Ministero della Salute (2004) Banca dati sui ricoveri ospedalieri anno
Lloyd A, Aitken JA, Hoffmeyer UK, Kelso EJ, Wakerly EC, Barber ND (1997) Economic evaluation of the use of nadroparin calcium in the prophylaxis of deep vein thrombosis and pulmonary embolism in surgical patient in Italy. Pharmacoeconomics 12:475–485
Nuijten MJ, Berto P, Kose J, Nadipelli V, Cimminiello C, Spreafico A (2002) Cost-effectiveness of enoxaparin as thrombophylaxis in acutely ill medical patient from the Italian NHS perspective. Prog Med 93:80–91
Attanasio E, Russo P, Carunchio G, Caprino L (2001) Dermatan sulfate versus unfractionated heparin for the prevention of venous thromboembolism in patients undergoing surgery for cancer. A cost-effectiveness analysis. Pharmacoeconomics 19:57–68
Nomenclatore Tariffario di Assistenza Specialistica Ambulatoriale (1996) DM 22 Luglio
Agenzia per i Servizi Sanitari Regionali (2003) Ricoveri, personale e spesa delle aziende ospedaliere
Ministero dell’Economia e delle Finanze (2005) Relazione generale sulla situazione economica del Paese
DGR n. 1843—Pubblicata sul BUR Campania n. 1 del 2 gennaio 2006 (2006–2008) Equilibrio economico delle ASL, delle AO, delle AO universitarie e della Fondazione Pascale. Disposizioni per la programmazione
Tariffa Unica Convenzionale per le Prestazioni di Assistenza Ospedaliera per Acuti
Agenzia Italiana del Farmaco; Lista di rimborsabilità Fascia A—Fascia H
Gazzetta Ufficiale della Repubblica Italiana determ. 06702/2007—n 41 del 19/02/2007
Hawkins D (2004) Pharamcoeconomic of thrombosis management. Pharmacotherapy 24(7 Pt2):95S–99S (review)
Shorr AF, Sarnes MW, Peeples PJ, Stanford RH, Happe LE, Farrelly E (2007) Comparison of cost, effectiveness, and safety of injectable anticoagulants used for thromboprophylaxis after orthopedic surgery. Am J Health Syst Pharm 64:2349–2355
Serafini S, Beltrametti C, Siragusa S, Barone M, Piovella F (1997) Post-thrombotic syndrome after asymptomatic postoperative deep-vein thrombosis. An inception cohort study. Thrombos Haemosrtas 76:P2930 (abstr.)
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.
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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