A Caprini Risk Score-Based Cost-Effectiveness Analysis of Enoxaparin for the Thromboprophylaxis of Patients After Nonorthopedic Surgery in a Chinese Healthcare Setting

• Published in: Clinical drug investigation Vol. 40; no. 2; pp. 161 - 171
• Main Authors: Bao, Yun, Zhao, Gang, Qu, Shuli, Xiong, Tengbin, Yao, Xingxing, Wu, Bin
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.02.2020; Springer Nature B.V
• Subjects: Bone surgery; Clinical medicine; Cost analysis; Embolisms; Internal Medicine; Medicine; Medicine & Public Health; Mortality; Original Research Article; Orthopedics; Pharmacology/Toxicology; Pharmacotherapy; Prevention; Studies; Surgical outcomes; Thromboembolism; Thrombosis; China
• ISSN: 1173-2563; 1179-1918
• DOI: 10.1007/s40261-019-00876-4

Background Venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE), is an important cause of post-surgery morbidity and mortality. However, it is unclear whether thromboprophylaxis with the low-molecular-weight heparin (LMWH) enoxaparin after non-orthopedic surgery could balance the cost and clinical outcomes or not. Objectives The purpose of this research was to evaluate the cost-effectiveness of enoxaparin for the universal prophylaxis of VTE and associated long-term complications in patients after non-orthopedic surgery compared with no prevention in a Chinese healthcare setting. Methods A decision model, which included both acute VTE and long-term complications, was developed to assess the economic outcomes of the two strategies for patients after non-orthopedic surgery. Quality-adjusted life years (QALYs) and direct medical costs were measured over a 5-year horizon. Incremental cost-effectiveness ratios (ICERs) were calculated. Results Compared with no prevention, patients under enoxaparin treatment with Caprini risk scores of 3–4, 5–6, 7–8, and ≥ 9 increased by 0.012, 0.017, 0.034, and 0.102 in QALYs, respectively. The results were either that ICERs of thromboprophylaxis with enoxaparin over no prevention were lower than the thresholds or that thromboprophylaxis with enoxaparin was dominant. For patients with a Caprini risk score ≥ 9, thromboprophylaxis with enoxaparin is dominant across the whole drug use duration range. The sensitivity analysis confirmed the results. Conclusions As the first analysis evaluating the economic outcomes of enoxaparin in patients undergoing general non-orthopedic surgery, this study suggests that thromboprophylaxis with enoxaparin is highly cost-effective compared with no prevention in patients with Caprini risk score ≥ 3.