This paper examines the relative cost-effectiveness of enoxaparin and warfarin as prophylactic therapy for the prevention of deep vein thrombosis (DVT) in patients undergoing knee replacement surgery in a managed care setting.
Although enoxaparin is more expensive than warfarin, it is also more effective in the prevention of DVT after knee replacement surgery.
To date there has been no comprehensive assessment of the cost-effectiveness of the alternative agents used for this purpose.
This evaluation is undertaken using a decision model that contrasts enoxaparin and warfarin regimens.
The model takes explicit account of the incidence of proximal DVT, distal DVT, pulmonary embolism (PE), and major bleeds.
The probabilities of clinical events are taken from data from a published randomized, controlled, clinical trial.
Key assumptions are that PEs derive only from asymptomatic proximal DVTs and that a false-positive diagnosis of DVT is made in 10% of cases.
Unit resource cost data are taken from pharmacoeconomic studies of DVT prophylaxis in hip replacement surgery.
The analysis focuses on the actual or expected cost of prophylactic treatment using enoxaparin as opposed to warfarin and, as appropriate measures of cost-effectiveness, the cost per DVT event avoided and the cost per incidence of PE avoided.
The expected cost of warfarin prophylaxis is $105 less per patient than that of enoxaparin. (...)
Mots-clés Pascal : Enoxaparine sodique, Warfarine, Thrombose, Veine profonde, Embolie pulmonaire, Héparine bas poids moléculaire, Antivitamine K, Anticoagulant, Chimiothérapie, Prévention, Homme, Chirurgie orthopédique, Prothèse, Genou, Membre inférieur, Etude comparative, Coumarine dérivé, Appareil circulatoire pathologie, Vaisseau sanguin pathologie, Veine pathologie, Appareil respiratoire pathologie, Coût, Economie santé, Analyse coût efficacité
Mots-clés Pascal anglais : Enoxaparin sodium, Warfarin, Thrombosis, Deep vein, Pulmonary embolism, Low molecular weight heparin, Antivitamin K, Anticoagulant, Chemotherapy, Prevention, Human, Orthopedic surgery, Prosthesis, Knee, Lower limb, Comparative study, Coumarine derivatives, Cardiovascular disease, Vascular disease, Venous disease, Respiratory disease, Costs, Health economy, Cost efficiency analysis
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 98-0189339
Code Inist : 002B02G. Création : 11/09/1998.