Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
The European Journal of Health Economics
Published in: The European Journal of Health Economics 4/2007

01-12-2007 | Original paper

Cost-effectiveness of extended prophylaxis with fondaparinux compared with low molecular weight heparin against venous thromboembolism in patients undergoing hip fracture surgery

Authors: Jonas Lundkvist, David Bergqvist, Bengt Jönsson

Published in: The European Journal of Health Economics | Issue 4/2007

Login to get access

Abstract

A model was developed to estimate costs and clinical effectiveness of fondaparinux compared with enoxaparin after hip fracture surgery in Sweden. Outcomes and costs of venous thromboembolism (VTE)-related care from a health care perspective were incorporated, with symptomatic deep-vein thrombosis and pulmonary embolism, recurrent VTE, post-thrombotic syndrome, major haemorrhage and all-cause death being included. Event probabilities were derived from fondaparinux clinical trial data and published data. VTE-related resource use and associated costs as well as costs of prophylaxis were based on local Swedish data. Extended prophylaxis with fondaparinux could avoid an additional 28 symptomatic VTE per 1,000 patients compared with extended prophylaxis with enoxaparin in hip fracture surgery patients. Although the prophylaxis costs were higher in the fondaparinux group, these were offset by the lower costs associated with treating fewer VTE, which thus indicates that extended fondaparinux prophylaxis is the dominant alternative when compared with enoxaparin in hip fracture surgery.
Literature
1.
Blodpropp-förebyggande, diagnostik o behandling av venös tromboembolism (in Swedish): The Swedish Council on Technology Assessment in Health Care (SBU), Linköping (2002)
2.
Saunders, M.E., Grant, R.E.: Cost effectiveness of low-molecular weight heparin versus warfarin following hip replacement surgery. J. Natl. Med. Assoc. 90(11), 677–680 (1998)
3.
Menzin, J., Colditz, G.A., Regan, M.M., Richner, R.E., Oster, G.: Cost-effectiveness of enoxaparin vs low-dose warfarin in the prevention of deep-vein thrombosis after total hip replacement surgery. Arch. Intern. Med. 155(7), 757–764 (1995)CrossRef
4.
Lundkvist, J., Bergqvist, D., Jönsson, B.: Cost effectiveness of fondaparinux compared to enoxaparin as venous thromboembolism prophylaxis in Sweden. Eur. J. Health Econ. 4(4), 254–262 (2003)CrossRef
5.
Balen, R.M., Marra, C.A., Zed, P.J., Cohen, M., Frighetto, L.: Cost-effectiveness analysis of enoxaparin versus unfractionated heparin for acute coronary syndromes. A Canadian hospital perspective. Pharmacoeconomics 16(5 Pt 2), 533–542 (1999)CrossRef
6.
Bergqvist, D.: Enoxaparin: a pharmacoeconomic review of its use in the prevention and treatment of venous thromboembolism and in acute coronary syndromes. Pharmacoeconomics 20(4), 225–243 (2002)CrossRef
7.
Geerts, W.H., Heit, J.A., Clagett, G.P., Pineo, G.F., Colwell, C.W., et al.: Prevention of venous thromboembolism. Chest 119(1 Suppl), 132S–175S (2001)CrossRef
8.
9.
Eikelboom, J.W., Quinlan, D.J., Douketis, J.D.: Extended-duration prophylaxis against venous thromboembolism after total hip or knee replacement: a meta-analysis of the randomised trials. Lancet 358(9275), 9–15 (2001)CrossRef
10.
Bergqvist, D., Jonsson, B.: Cost-effectiveness of prolonged out-of-hospital prophylaxis with low-molecular-weight heparin following total hip replacement. Haemostasis 30 Suppl 2130–2135; discussion 128–129 (2000)
11.
Hull, R.D., Pineo, G.F., Stein, P.D., Mah, A.F., MacIsaac, S.M., et al.: Extended out-of-hospital low-molecular-weight heparin prophylaxis against deep venous thrombosis in patients after elective hip arthroplasty: a systematic review. Ann. Intern. Med. 135(10), 858–869 (2001)
12.
Davies, L., Richardson, G., Cohen, A.: Economic evaluation of enoxaparin as postdischarge prophylaxis for deep vein thrombosis (DVT) in elective hip surgery. Value Health 3(6), 397–406 (2000)CrossRef
13.
Detournay, B., Planes, A., Vochelle, N., Fagnani, F.: Cost effectiveness of a low-molecular-weight heparin in prolonged prophylaxis against deep vein thrombosis after total hip replacement. Pharmacoeconomics 13(1 Pt 1), 81–89 (1998)CrossRef
14.
Eriksson, B.I., Lassen, M.R.: Duration of prophylaxis against venous thromboembolism with fondaparinux after hip fracture surgery: a multicenter, randomized, placebo-controlled, double-blind study. Arch. Intern. Med. 163(11), 1337–42 (2003)CrossRef
15.
Gordois, A.: The cost-effectiveness of fondaparinux compared with enoxaparin as prophylaxis against thromboembolism following major orthopedic surgery. J. Thromb. Haemost. 1(10), 2167–2174 (2003)CrossRef
16.
Sullivan, S.: Cost-effectiveness of fondaparinux compared with enoxaparin as prophylaxi against venous thromboembolsim in patients undergoing major orthopedic surgery. Blood 100(11), 871 (2002)
17.
Lassen, M.R., Borris, L.C., Anderson, B.S., Jensen, H.P., Skejo Bro, H.P., et al.: Efficacy and safety of prolonged thromboprophylaxis with a low molecular weight heparin (dalteparin) after total hip arthroplasty–the Danish Prolonged Prophylaxis (DaPP) Study. Thromb. Res. 89(6), 281–287 (1998)CrossRef
18.
Turpie, A.G., Bauer, K.A., Eriksson, B.I., Lassen, M.R.: Postoperative fondaparinux versus postoperative enoxaparin for prevention of venous thromboembolism after elective hip-replacement surgery: a randomised double-blind trial. Lancet 359(9319), 1721–1726 (2002)CrossRef
19.
Eriksson, B.I., Bauer, K.A., Lassen, M.R., Turpie, A.G.: Fondaparinux compared with enoxaparin for the prevention of venous thromboembolism after hip-fracture surgery. N. Engl. J. Med. 345(18), 1298–1304 (2001)CrossRef
20.
White, R.H., Romano, P.S., Zhou, H., Rodrigo, J., Bargar, W.: Incidence and time course of thromboembolic outcomes following total hip or knee arthroplasty. Arch. Intern. Med. 158(14), 1525–1531 (1998)CrossRef
21.
Devlin, J.W., Petitta, A., Shepard, A.D., Obeid, F.N.: Cost-effectiveness of enoxaparin versus low-dose heparin for prophylaxis against venous thrombosis after major trauma. Pharmacotherapy 18(6), 1335–1342 (1998)
22.
Drummond, M., Aristides, M., Davies, L., Forbes, C.: Economic evaluation of standard heparin and enoxaparin for prophylaxis against deep vein thrombosis in elective hip surgery. Br. J. Surg. 81(12), 1742–1746 (1994)CrossRef
23.
Hillson, S.D., Rich, E.C.: Two strategies for prophylaxis of fatal postoperative pulmonary embolism. Cost-effectiveness analysis. Int. J. Technol. Assess Health Care 6(3), 470–479 (1990)CrossRef
24.
Hawkins, D.W., Langley, P.C., Krueger, K.P.: Pharmacoeconomic model of enoxaparin versus heparin for prevention of deep vein thrombosis after total hip replacement. Am. J. Health Syst. Pharm. 54(10), 1185–1190 (1997)
25.
Levin, L.A., Horst, M., Bergqvist, D.: Economic evaluation of desirudin vs heparin in deep vein thrombosis prevention after hip replacement surgery. Pharmacoeconomics 13(1 Pt 2), 111–118 (1998)CrossRef
26.
Levin, L.A., Bergqvist, D.: Cost effectiveness of desirudin compared with a low molecular weight heparin in the prevention of deep vein thrombosis after total hip replacement surgery. Pharmacoeconomics 19(5 Pt 2), 589–597 (2001)CrossRef
27.
Lloyd, A: Economic evaluation of the use of enoxaparin for thomboprophylaxis in acutely ill medical patients. J. Drug Assess. 4145–159
28.
Lloyd, A., Aitken, J.A., Hoffmeyer, U.K., Kelso, E.J., Wakerly, E.C., et al.: Economic evaluation of the use of nadroparin calcium in the prophylaxis of deep vein thrombosis and pulmonary embolism in surgical patients in Italy. Pharmacoeconomics 12(4), 475–485 (1997)
29.
Nicolaides, A., Bosanquet, N.: Cost-effectiveness of desirudin in the prevention of the thromboemebolism complications of surgery. J. Drug Assess. 2353–2364 (1999)
30.
O’Brien, B.J., Anderson, D.R., Goeree, R.: Cost-effectiveness of enoxaparin versus warfarin prophylaxis against deep-vein thrombosis after total hip replacement. Cmaj 150(7), 1083–1090 (1994)
31.
Oster, G., Tuden, R.L., Colditz, G.A.: A cost-effectiveness analysis of prophylaxis against deep-vein thrombosis in major orthopedic surgery. JAMA 257(2), 203–8 (1987)CrossRef
32.
Oster, G., Tuden, R.L., Colditz, G.A.: Prevention of venous thromboembolism after general surgery. Cost-effectiveness analysis of alternative approaches to prophylaxis. Am. J. Med. 82(5), 889–99 (1987)CrossRef
33.
Pechevis, M.: Economic evaluation of enoxaparin vs. placebo for the prevention of venous thromboembolism in acutely III medical patients. Value Health 3(6), 389–396 (2000)CrossRef
34.
Szucs, T.D., Schramm, W.: The cost-effectiveness of low-molecular-weight heparin vs unfractionated heparin in general and orthopaedic surgery: an analysis for the German healthcare system. Pharmacol. Res. 40(1), 83–89 (1999)CrossRef
35.
Prandoni, P., Lensing, A.W., Cogo, A., Cuppini, S., Villalta, S., et al.: The long-term clinical course of acute deep venous thrombosis. Ann. Intern. Med. 125(1), 1–7 (1996)
36.
Hull, R., Delmore, T., Carter, C., Hirsh, J., Genton, E., et al.: Adjusted subcutaneous heparin versus warfarin sodium in the long-term treatment of venous thrombosis. N. Engl. J. Med. 306(4), 189–194 (1982)CrossRef
37.
Hull, R., Hirsh, J., Jay, R., Carter, C., England, C., et al.: Different intensities of oral anticoagulant therapy in the treatment of proximal-vein thrombosis. N. Engl. J. Med. 307(27), 1676–1681 (1982)CrossRef
38.
Lagerstedt, C.I., Olsson, C.G., Fagher, B.O., Oqvist, B.W., Albrechtsson, U.: Need for long-term anticoagulant treatment in symptomatic calf-vein thrombosis. Lancet 2(8454), 515–518 (1985)CrossRef
39.
Pini, M., Aiello, S., Manotti, C., Pattacini, C., Quintavalla, R., et al.: Low molecular weight heparin versus warfarin in the prevention of recurrences after deep vein thrombosis. Thromb. Haemost. 72(2), 191–197 (1994)
40.
Schulman, S., Rhedin, A.S., Lindmarker, P., Carlsson, A., Larfars, G., et al.: A comparison of six weeks with six months of oral anticoagulant therapy after a first episode of venous thromboembolism. Duration of Anticoagulation Trial Study Group. N. Engl. J. Med. 332(25), 1661–1665 (1995)CrossRef
41.
Das, S.K., Cohen, A.T., Edmondson, R.A., Melissari, E., Kakkar, V.V.: Low-molecular-weight heparin versus warfarin for prevention of recurrent venous thromboembolism: a randomized trial. World J. Surg. 20(5), 521–526; discussion 526–527 (1996)
42.
Ginsberg, J.S., Turkstra, F., Buller, H.R., MacKinnon, B., Magier, D., et al.: Postthrombotic syndrome after hip or knee arthroplasty: a cross-sectional study. Arch. Intern. Med. 160(5), 669–672 (2000)CrossRef
43.
Siragusa, S., Beltrametti, C., Barone, M., Piovella, F.: Clinical course and incidence of post-thrombophlebitic syndrome after profound asymptomatic deep vein thrombosis. Results of a transverse epidemiologic study. Minerva Cardioangiol. 45(3), 57–66 (1997)
44.
Life tables. Statistic Sweden, Stockholm (2003)
45.
Johnell, O., Kanis, J.A., Oden, A., Sernbo, I., Redlund-Johnell, I., et al.: Mortality after osteoporotic fractures. Osteoporos. Int. 15(1), 38–42 (2004)CrossRef
46.
Braithwaite, R.S., Col, N.F., Wong, J.B.: Estimating hip fracture morbidity, mortality and costs. J. Am. Geriatr. Soc. 51(3), 364–370 (2003)CrossRef
47.
Kanis, J.A., Oden, A., Johnell, O., De Laet, C., Jonsson, B., et al.: The components of excess mortality after hip fracture. Bone 32(5), 468–473 (2003)CrossRef
48.
Manning, W.G.: The logged dependent variable, heteroscedasticity, and the retransformation problem. J. Health Econ. 17(3), 283–295 (1998)CrossRef
49.
Manning, W.G., Mullahy, J.: Estimating log models: to transform or not to transform? J. Health Econ. 20(4), 461–494 (2001)CrossRef
50.
LINFO FASS Läkemedel i Sverige (Swedish drug prices). Läkemedelsinformation AB: Oslo (2003)
51.
STIQS project-fifth report (Data on file, Sanofi Synthelabo) (2003)
52.
Lapidus, L., Borretzen, J., Fahlen, M., Thomsen, H.G., Hasselblom, S., et al.: Home treatment of deep vein thrombosis. An out-patient treatment model with once-daily injection of low-molecular-weight heparin (tinzaparin) in 555 patients. Pathophysiol. Haemost. Thromb. 32(2), 59–66 (2002)CrossRef
53.
Landstingsförbundet, Kostnad per intagen patient (Cost per admitted patient). Stockholm County Council (1999)
54.
Dahl, O.E., Andreassen, G., Aspelin, T., Muller, C., Mathiesen, P., et al.: Prolonged thromboprophylaxis following hip replacement surgery—results of a double-blind, prospective, randomised, placebo-controlled study with dalteparin (Fragmin). Thromb. Haemost. 77(1), 26–31 (1997)
55.
Manganelli, D., Pazzagli, M., Mazzantini, D., Punzi, G., Manca, M., et al.: Prolonged prophylaxis with unfractioned heparin is effective to reduce delayed deep vein thrombosis in total hip replacement. Respiration 65(5), 369–374 (1998)CrossRef
56.
Heit, J.A., Elliott, C.G., Trowbridge, A.A., Morrey, B.F., Gent, M., et al.: Ardeparin sodium for extended out-of-hospital prophylaxis against venous thromboembolism after total hip or knee replacement. A randomized, double-blind, placebo-controlled trial. Ann. Intern. Med. 132(11), 853–861 (2000)
57.
Leclerc, J.R., Gent, M., Hirsh, J., Geerts, W.H., Ginsberg, J.S.: The incidence of symptomatic venous thromboembolism after enoxaparin prophylaxis in lower extremity arthroplasty: a cohort study of 1,984 patients. Canadian Collaborative Group. Chest 114(2 Suppl Evidence), 115S–118S (1998)
58.
Colwell, C.W. Jr., Collis, D.K., Paulson, R., McCutchen, J.W., Bigler, G.T., et al.: Comparison of enoxaparin and warfarin for the prevention of venous thromboembolic disease after total hip arthroplasty. Evaluation during hospitalization and three months after discharge. J. Bone Joint Surg. Am. 81(7), 932–40 (1999)
59.
Pellegrini, V.D. Jr., Clement, D., Lush-Ehmann, C., Keller, G.S., Evarts, C.M.: The John Charnley Award. Natural history of thromboembolic disease after total hip arthroplasty. Clin Orthop (333), 27–40 (1996)
60.
Hansson, P.O., Sorbo, J., Eriksson, H.: Recurrent venous thromboembolism after deep vein thrombosis: incidence and risk factors. Arch. Intern. Med. 160(6), 769–74 (2000)CrossRef
Metadata
Title
Cost-effectiveness of extended prophylaxis with fondaparinux compared with low molecular weight heparin against venous thromboembolism in patients undergoing hip fracture surgery
Authors
Jonas Lundkvist
David Bergqvist
Bengt Jönsson
Publication date
01-12-2007
Publisher
Springer-Verlag
Published in
The European Journal of Health Economics / Issue 4/2007
Print ISSN: 1618-7598
Electronic ISSN: 1618-7601
DOI
https://doi.org/10.1007/s10198-006-0017-2

Other articles of this Issue 4/2007

The European Journal of Health Economics 4/2007 Go to the issue

Original Paper

The incidence and cost of cardiac surgery adverse events in Australian (Victorian) hospitals 2003–2004

Pricing and Reimbursement Systems in Europe

Assessment of the pharmaceutical market in Poland after accession to the European Union

Original paper

Foreign direct investment in the health care sector and most-favoured locations in developing countries

Original paper

The impact of home hospitalization on healthcare costs of exacerbations in COPD patients

Erratum

Costs and quality of life in multiple sclerosis in The Netherlands

Editorial

Tobacco policies in the European Union: a need for state and continental harmonisation?