Cost-effectiveness of prophylaxis and treatment of venous thromboembolic disease (VTE) in patients undergoing hip surgery in Mexico

Abstract

Objective: Hip surgery is a risk factor to develop venous thromboembolism (VTE). The purpose of this study was to estimate the cost-effectiveness of VTE prevention and treatment in patients having undergone hip surgery from the Mexican institutional perspective. Methods: A Markov model was performed to estimate one-year health and economic consequences (one-week cycles). Effectiveness measures (EM) were: number of incident deep vein thrombosis (DVT) and pulmonary thromboembolism (PE) events reduction, as well as hospital admissions (HA) and deaths avoided. Prophylactic doses of comparators were: warfarin (5 mg/day, reference alternative); acenocoumarol (4 mg/day); dalteparin (5,000 IU/day); enoxaparin (40 mg/day); nadroparin (5,700 IU/day); unfractionated heparin plus warfarin (10,000 IU/day + 5 mg/day), fondaparinux (2.5 mg/day) and no-prophylaxis. Resource use and costs were obtained from databases from the Social Security Mexican Institute. Acceptability curves were constructed. Results: Due to poor health outcomes, no-prophylaxis is the alternative that represents the gr eatest financial burden to the institution. Acenocoumarol, enoxaparin, nadroparin and unfractionated heparin showed higher cost and lower outcomes than warfarin in at least one EM. Although both, dalteparin and fondaparinux presented better outcomes than warfarin in all EM, dalteparin showed lower incremental cost-effectiveness ratios than fondaparinux: US$33,000 vs. US$47,800, US$45,900 vs. US$151,200, US$66,300 vs. US$272,200 andUS$31,400 vs. US$54,400 (per additional DVT, PE, death and HA avoided, respectively). Acceptability curves showed that dalteparin is more cost-effective than enoxaparin. Conclusion: Regarding the reduction of VTE related events, dalteparin represents the most cost-effective alternative among other current pharmacological therapies in Mexican patients having undergone hip surgery