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Cost effectiveness of outpatient anticoagulant prophylaxis after total hip arthroplasty

W E Wade1, D W Hawkins

  • 1College of Pharmacy, University of Georgia, Athens 30602, USA.

Orthopedics
|May 3, 2000
PubMed

Insights

Low-dose warfarin daily is a cost-effective strategy for preventing deep venous thrombosis (DVT) and pulmonary embolism (PE) after total hip arthroplasty (THA). This approach offers significant cost savings compared to other pharmacoprophylaxis regimens.

Area of Science:

  • Orthopedic Surgery
  • Vascular Medicine
  • Health Economics

Background:

  • Deep venous thrombosis (DVT) and pulmonary embolism (PE) are significant risks following total hip arthroplasty (THA).
  • The risk of these thromboembolic events can persist for up to 3 months post-surgery.
  • Current guidelines address prophylaxis, but cost-effectiveness of different regimens requires analysis.

Purpose of the Study:

  • To conduct a cost-effectiveness analysis of three pharmacoprophylaxis regimens for DVT and PE in THA patients.
  • To compare the economic impact of low-dose warfarin versus enoxaparin regimens.
  • To inform clinical decisions regarding extended post-discharge prophylaxis.

Main Methods:

  • Cost-effectiveness analysis based on literature-reported incidences of DVT and PE post-THA.
  • Evaluation of three pharmacoprophylaxis strategies: low-dose warfarin daily, enoxaparin 40 mg daily, and a combination regimen.
  • Calculation of cost savings per thromboembolic event avoided for each regimen.

Main Results:

  • Routine low-dose warfarin daily is projected to save $21,466.89 per avoided thromboembolic event compared to enoxaparin 40 mg daily.
  • A combination of enoxaparin 40 mg for 4 days plus warfarin daily offers savings of $18,618.10 per avoided event versus enoxaparin alone.
  • Warfarin-based strategies demonstrate superior cost-effectiveness.

Conclusions:

  • Low-dose warfarin daily represents a highly cost-effective option for DVT and PE prophylaxis after THA.
  • Combination therapy (enoxaparin + warfarin) also presents a cost-effective alternative to enoxaparin monotherapy.
  • Clinicians may consider extended prophylaxis with enoxaparin and warfarin post-discharge pending further research.

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