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The cost-effectiveness of fondaparinux compared with enoxaparin as prophylaxis against thromboembolism following major orthopedic surgery

Gordois, A., Posnett, J., Borris, L., Bossuyt, P., Jonsson, B., Levy, E. and De Pouvourville, G. (2003) The cost-effectiveness of fondaparinux compared with enoxaparin as prophylaxis against thromboembolism following major orthopedic surgery. Journal of Thrombosis and Haemostasis, 1 (10). pp. 2167-2174. ISSN 1538-7933

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Background: The selective antithrombotic fondaparinux is more effective than the low-molecular-weight heparin enoxaparin for prevention of venous thromboembolism (deep-vein thrombosis [DVT] or pulmonary embolism) in patients undergoing major orthopedic surgery, but its cost-effectiveness is undetermined. Objectives: To evaluate the cost-effectiveness of fondaparinux relative to enoxaparin as prophylaxis against venous thromboembolism (VTE) for patients undergoing total hip replacement, total knee replacement or hip fracture surgery in the UK. Patients/methods: A decision analysis model was created simulating the impact of fondaparinux and enoxaparin on patient outcomes and costs over various time points up to 5 years following surgery. The main outcome measures were treatment costs per patient and the incidence of clinical VTE and VTE-related deaths. A weighted (combined) cohort reflects the proportion of patients undergoing these procedures in 2000/2001. Results: In the combined cohort, compared with enoxaparin, fondaparinux is expected to produce 20 fewer clinical VTE events and 3.2 fewer VTE-related deaths per 1000 procedures at 5 years. Cost savings at 5 years are £27 per patient with fondaparinux (discounted at 6% per year). In each of the three surgical groups, fondaparinux leads to lower expected costs per patient and to a smaller number of VTE events and VTE-related deaths. Results are sensitive to the price difference between fondaparinux and enoxaparin and variation in the rate of late DVT. The analysis is robust to variations in all other key parameters. Conclusions: Compared with enoxaparin, fondaparinux is more effective and reduces costs to the healthcare system. At current prices, fondaparinux is the recommended strategy in the UK for prophylaxis following major orthopedic surgery.

Item Type: Article
Copyright, Publisher and Additional Information: Open access copy available from the journal web site.
Keywords: cost-effectiveness, fondaparinux, orthopedic surgery, venous thromboembolism
Institution: The University of York
Academic Units: The University of York > York Health Economics Consortium (York)
Depositing User: Open Access From Journal
Date Deposited: 23 Dec 2008 10:33
Last Modified: 23 Dec 2008 10:33
Published Version: http://dx.doi.org/10.1046/j.1538-7836.2003.00396.x
Status: Published
Publisher: Wiley-Blackwell
Refereed: Yes
Identification Number: 10.1046/j.1538-7836.2003.00396.x
URI: http://eprints.whiterose.ac.uk/id/eprint/5089

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