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Cost consequence analysis of fondaparinux versus enoxaparin in the prevention of venous thromboembolism after major orthopaedic surgery in Belgium

(2004) ACTA CLINICA BELGICA. 59(6). p.346-357
Author
Organization
Abstract
Fondaparinux, a selective inhibitor of activated factor X, has been shown to reduce further the risk of venous thromboembolism (VTE) in major orthopaedic surgery compared to the low molecular weight heparin enoxaparin, when both were applied for 7 days after surgery. To compare the expected costs and clinical outcomes of fondaparinux with enoxaparin applied for 7 days after surgery, we conducted a cost-consequence analysis in patients undergoing major orthopaedic surgery, i.e. total hip replacement, total knee replacement and hip fracture repair. Our decision model included endpoints relevant in routine clinical practice and the natural history of VTE over a long term period of 5 years. Costs for prevention, diagnosis and treatment of VTE and its complications were estimated from the Belgian health care payer perspective. Analyses were conducted for different time horizons and for the three indications, separately, and then combined. Overall, our results indicated that the initial investment in fondaparinux (cost per day: 10.39 Euro versus 3.74 Euro for enoxaparin) was soon compensated by savings due to avoided VTE events, with cost neutrality being achieved after 90 days and further savings being incurred over longer time periods mainly due to avoided post-thrombotic syndromes. These findings were most pronounced in patients undergoing hip fracture repair. Sensitivity analyses showed these findings to be robust for the three indications separately, and combined. We conclude that our analysis of health and economic consequences over a long term period, demonstrates the value for money of fondaparinux versus enoxaparin for the prevention of VTE events after total hip replacement, total knee replacement and hip fracture repair.
Keywords
cost consequence analysis, prevention of venous thromboembolism, major orthopaedic surgery, Belgium, DEEP-VEIN THROMBOSIS, MOLECULAR-WEIGHT HEPARIN, HIP-REPLACEMENT SURGERY, RANDOMIZED DOUBLE-BLIND, ORAL ANTICOAGULANT-THERAPY, UNFRACTIONATED HEPARIN, KNEE REPLACEMENT, POSTOPERATIVE FONDAPARINUX, POSTTHROMBOTIC SYNDROME, STANDARD HEPARIN

Citation

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Chicago
Annemans, Lieven, MC Minjoulat-Rey, M De Knock, K Vranckx, M Czarka, S Gabriel, and P Haentjens. 2004. “Cost Consequence Analysis of Fondaparinux Versus Enoxaparin in the Prevention of Venous Thromboembolism After Major Orthopaedic Surgery in Belgium.” Acta Clinica Belgica 59 (6): 346–357.
APA
Annemans, Lieven, Minjoulat-Rey, M., De Knock, M., Vranckx, K., Czarka, M., Gabriel, S., & Haentjens, P. (2004). Cost consequence analysis of fondaparinux versus enoxaparin in the prevention of venous thromboembolism after major orthopaedic surgery in Belgium. ACTA CLINICA BELGICA, 59(6), 346–357.
Vancouver
1.
Annemans L, Minjoulat-Rey M, De Knock M, Vranckx K, Czarka M, Gabriel S, et al. Cost consequence analysis of fondaparinux versus enoxaparin in the prevention of venous thromboembolism after major orthopaedic surgery in Belgium. ACTA CLINICA BELGICA. 2004;59(6):346–57.
MLA
Annemans, Lieven, MC Minjoulat-Rey, M De Knock, et al. “Cost Consequence Analysis of Fondaparinux Versus Enoxaparin in the Prevention of Venous Thromboembolism After Major Orthopaedic Surgery in Belgium.” ACTA CLINICA BELGICA 59.6 (2004): 346–357. Print.
@article{305995,
  abstract     = {Fondaparinux, a selective inhibitor of activated factor X, has been shown to reduce further the risk of venous thromboembolism (VTE) in major orthopaedic surgery compared to the low molecular weight heparin enoxaparin, when both were applied for 7 days after surgery. 
To compare the expected costs and clinical outcomes of fondaparinux with enoxaparin applied for 7 days after surgery, we conducted a cost-consequence analysis in patients undergoing major orthopaedic surgery, i.e. total hip replacement, total knee replacement and hip fracture repair. Our decision model included endpoints relevant in routine clinical practice and the natural history of VTE over a long term period of 5 years. Costs for prevention, diagnosis and treatment of VTE and its complications were estimated from the Belgian health care payer perspective. Analyses were conducted for different time horizons and for the three indications, separately, and then combined. 
Overall, our results indicated that the initial investment in fondaparinux (cost per day: 10.39 Euro versus 3.74 Euro for enoxaparin) was soon compensated by savings due to avoided VTE events, with cost neutrality being achieved after 90 days and further savings being incurred over longer time periods mainly due to avoided post-thrombotic syndromes. These findings were most pronounced in patients undergoing hip fracture repair. Sensitivity analyses showed these findings to be robust for the three indications separately, and combined. 
We conclude that our analysis of health and economic consequences over a long term period, demonstrates the value for money of fondaparinux versus enoxaparin for the prevention of VTE events after total hip replacement, total knee replacement and hip fracture repair.},
  author       = {Annemans, Lieven and Minjoulat-Rey, MC and De Knock, M and Vranckx, K and Czarka, M and Gabriel, S and Haentjens, P},
  issn         = {0001-5512},
  journal      = {ACTA CLINICA BELGICA},
  keyword      = {cost consequence analysis,prevention of venous thromboembolism,major orthopaedic surgery,Belgium,DEEP-VEIN THROMBOSIS,MOLECULAR-WEIGHT HEPARIN,HIP-REPLACEMENT SURGERY,RANDOMIZED DOUBLE-BLIND,ORAL ANTICOAGULANT-THERAPY,UNFRACTIONATED HEPARIN,KNEE REPLACEMENT,POSTOPERATIVE FONDAPARINUX,POSTTHROMBOTIC SYNDROME,STANDARD HEPARIN},
  language     = {eng},
  number       = {6},
  pages        = {346--357},
  title        = {Cost consequence analysis of fondaparinux versus enoxaparin in the prevention of venous thromboembolism after major orthopaedic surgery in Belgium},
  volume       = {59},
  year         = {2004},
}

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