Cost-effectiveness of Enoxaparin vs Low-Dose Warfarin in the Prevention of Deep-Vein Thrombosis After Total Hip Replacement Surgery

doi:10.1001/archinte.1995.00430070117013

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Vol. 155 No. 7, 10 APRIL 1995

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Cost-effectiveness of Enoxaparin vs Low-Dose Warfarin in the Prevention of Deep-Vein Thrombosis After Total Hip Replacement Surgery

Joseph Menzin, PhD; Graham A. Colditz, MBBS, DrPH; Meredith M. Regan; Randel E. Richner, RN, MPH; Gerry Oster, PhD

Arch Intern Med. 1995;155(7):757-764.

Abstract

Background
Enoxaparin sodium, a low-molecular-weight heparin, was recentlyapproved for use in the United States to prevent deep-vein thrombosisafter total hip replacement surgery. Its cost-effectivenessrelative to prophylaxis with low-dose warfarin sodium is unknown.

Methods
A decision-analytic model was developed to compare two strategiesof prophylaxis for deep-vein thrombosis with a strategy of notusing prophylaxis in a hypothetical cohort of 10 000 patientsundergoing total hip replacement surgery. For each of thesestrategies, we estimated the expected number of cases of confirmeddeep-vein thrombosis or pulmonary embolism, the expected numberof thromboembolic deaths, and the expected costs of venous thromboemboliccare, including prophylaxis, diagnosis, and treatment. Datawere drawn primarily from the published literature.

Results
Compared with no prophylaxis, the use of low-dose warfarin wouldbe expected to reduce the number of cases of confirmed deep-veinthrombosis from about 1000 (per 10 000 patients) to 420 andthe number of thromboembolic deaths from about 250 to 110. Expectedcosts of care related to deep-vein thrombosis also would bereduced from approximately $530 to $330 per patient. Prophylaxiswith enoxaparin would be expected to reduce further the numberof cases of confirmed deep-vein thrombosis and the number ofthromboembolic deaths (to 250 and 70, respectively) but increasecosts of care by approximately $50 per patient. The cost-effectivenessof enoxaparin (relative to low-dose warfarin) is estimated tobe approximately $12 000 per death averted.

Conclusion
Although enoxaparin is more costly than low-dose warfarin, itscost-effectiveness in total hip replacement compares favorablywith that of other generally accepted medical interventions.

(Arch Intern Med. 1995;155:757-764)

Author Affiliations

From Policy Analysis Inc, Brookline, Mass (Drs Menzin and Oster and Mss Regan and Richner); and Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass (Dr Colditz). Ms Richner is now with SmithKline Beecham Pharmaceuticals, Philadelphia, Pa.

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