Comparison of the two-year outcomes and costs of prophylaxis in medical patients at risk of venous thromboembolism

Steven B. Deitelzweig; Russ Becker; Jay Lin; Josh Benner

doi:10.1160/TH08-04-0248

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2008; 100(05): 810-820
DOI: 10.1160/TH08-04-0248

Blood Coagulation, Fibrinolysis and Cellular Haemostasis

Schattauer GmbH

Comparison of the two-year outcomes and costs of prophylaxis in medical patients at risk of venous thromboembolism

Steven B. Deitelzweig

¹Ochsner Hospital, New Orleans, Louisianna, USA

,

Russ Becker

²IMS Health, Falls Church, Virginia, USA

,

Jay Lin

³sanofi-aventis, Bridgewater, New Jersey, USA

,

Josh Benner

²IMS Health, Falls Church, Virginia, USA

› Author Affiliations

Abstract

Summary

A decision-analytic model incorporating a Markov process to assess the incremental cost and effectiveness of venous throm-boembolism (VTE) prevention strategies was used. Modeling was carried out using a hypothetical cohort of medical patients at risk of VTE.The model compared clinical effectiveness (primary and recurrent VTE, death), safety (adverse events), and direct medical costs between patients receiving enoxaparin prophylaxis, unfractionated heparin (UFH) prophylaxis, and no prophylaxis (n=10,000 for each arm). Monte Carlo simulation was performed to identify changes in inputs that would affect the results.The estimated incidence of VTE at two years (including recurrentVTE) was 6.8% with enoxaparin prophylaxis, 7.9% with UFH prophylaxis,and 17.9% with no prophylaxis.Two-year mortality occurred in 15.7% of enoxaparin patients and 16.0% of UFH patients, with the incidences of major bleeding in these groups being 0.7% and 1.2%, respectively. However, both enoxaparin and UFH prophylaxis were associated with higher rates of major bleeds than no prophylaxis (0.6%).Total average costs per patient were (US dollars) $1,264 (for enoxaparin prophylaxis, $1,585 for UFH prophylaxis,and $2,245 for no prophylaxis).No realistic parameter changes resulted in enoxaparin prophylaxis being more costly than UFH prophylaxis. For the healthcare payer, considering all direct medical costs associated with VTE up to two years after an admission for acute illness, prophylaxis with enoxaparin was more effective and less costly than UFH. This identifies enoxaparin as a potentially favorable VTE prophylaxis regimen compared with UFH and no prophylaxis in at-risk medical patients

Keywords

Medical costs - venous thromboembolism - prophylaxis

Full Text

References

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