PMID- 12871354
OWN - NLM
STAT- MEDLINE
DCOM- 20040116
LR  - 20230829
IS  - 1538-7933 (Print)
IS  - 1538-7836 (Linking)
VI  - 1
IP  - 5
DP  - 2003 May
TI  - Investment in prolonged thromboprophylaxis with dalteparin improves clinical 
      outcomes after hip replacement.
PG  - 896-906
AB  - Clinical guidelines recommend the use of extended out-of-hospital 
      thromboprophylaxis in patients who have had major arthroplasty. However, the 
      cost-effectiveness of prolonging pharmacological thromboprophylaxis into the 
      out-of-hospital phase following hip replacement surgery remains the subject of 
      considerable debate. This debate centers on the clinical relevance of the 
      'surrogate' venographic endpoints that have been used in most clinical trials and 
      used to generate some of the cost analyses of thromboprophylaxis. The objective 
      of this study was to estimate, from the payer perspective, the direct medical 
      costs of prolonging the duration of thromboprophylaxis with dalteparin from 1 
      week to 28-35 days in patients undergoing hip replacement, and to compare these 
      to the costs associated with using 'standard' in-hospital thromboprophylaxis with 
      low-molecular-weight heparin (LMWH) or warfarin. To derive 'best' estimates for 
      rates of clinically and economically relevant thromboembolism associated with hip 
      replacement surgery (i.e. those that would in reality incur management costs), we 
      used data on the prevalence of both symptomatic and asymptomatic deep vein 
      thrombosis (DVT) and pulmonary embolism (PE). These estimates were used in 
      conjunction with diagnostic-related groups (DRG) reimbursement rates and a 
      dalteparin cost model, which assumed home-based self-administration for prolonged 
      thromboprophylaxis, to calculate overall direct medical costs of prolonged vs. 
      in-hospital thromboprophylaxis. The management costs of the strategies evaluated 
      were, to the nearest 1000 Euros: 465 000 Euros for in-hospital prophylaxis with 
      LMWH; 339 000 Euros for in-hospital prophylaxis with warfarin; and 368 000 Euros 
      for prolonged prophylaxis with dalteparin. For every 1000 patients treated, 
      prolonging thromboprophylaxis with dalteparin from 1 to 4-5 weeks will avoid 30 
      clinical DVTs and 18 PEs at a saving of 2000 Euros per clinical event. Compared 
      with in-hospital warfarin, prolonged thromboprophylaxis with dalteparin will 
      avoid 28 DVTs and four PEs at an incremental cost-effectiveness ratio of 900 
      Euros per clinical event avoided. We consider that investment in prolonged 
      thromboprophylaxis with dalteparin is justified for the improvement in clinical 
      outcomes produced.
FAU - Dahl, O E
AU  - Dahl OE
AD  - Department of Orthopaedics, Research Forum, Ullevaal University Hospital, Oslo, 
      Norway. oladahl@start.no
FAU - Pleil, A M
AU  - Pleil AM
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PL  - England
TA  - J Thromb Haemost
JT  - Journal of thrombosis and haemostasis : JTH
JID - 101170508
RN  - 5Q7ZVV76EI (Warfarin)
RN  - S79O08V79F (Dalteparin)
SB  - IM
MH  - Arthroplasty, Replacement, Hip/*adverse effects
MH  - Clinical Trials as Topic
MH  - Cost-Benefit Analysis
MH  - Dalteparin/*economics/*therapeutic use
MH  - Economics, Pharmaceutical
MH  - Humans
MH  - Perioperative Care/economics/methods
MH  - Thrombosis/economics/*prevention & control
MH  - Time Factors
MH  - Treatment Outcome
MH  - Warfarin/economics/therapeutic use
EDAT- 2003/07/23 05:00
MHDA- 2004/01/17 05:00
CRDT- 2003/07/23 05:00
PHST- 2003/07/23 05:00 [pubmed]
PHST- 2004/01/17 05:00 [medline]
PHST- 2003/07/23 05:00 [entrez]
AID - S1538-7836(22)15024-5 [pii]
AID - 10.1046/j.1538-7836.2003.00236.x [doi]
PST - ppublish
SO  - J Thromb Haemost. 2003 May;1(5):896-906. doi: 10.1046/j.1538-7836.2003.00236.x.