Enoxaparin for thromboprophylaxis after major trauma: potential cost implications

Area of Science:

• Medical Economics
• Trauma Surgery
• Pharmacoeconomics

Background:

• Venous thromboembolism (VTE) is a significant risk following major trauma.
• Thromboprophylaxis is crucial to prevent VTE in critically ill trauma patients.
• Comparing the cost-effectiveness of different anticoagulant agents is essential for optimizing patient care.

Purpose of the Study:

• To evaluate the cost-effectiveness of enoxaparin versus low-dose heparin (LDH) for VTE prevention in major trauma.
• To assess the economic impact of major bleeding associated with low-molecular-weight heparin (LMWH) use.

Main Methods:

• A decision model analysis was employed to compare enoxaparin and LDH.
• The model assessed the prevention of deep vein thromboses (DVTs) and the risks/costs of major hemorrhage.
• Data from prospective trials and financial studies informed the model estimates for a cohort of 1,000 trauma patients.

Main Results:

• Enoxaparin demonstrated a net savings of $391.23 per DVT prevented, despite higher drug costs and increased bleeding risk.
• Sensitivity analysis indicated the model is most sensitive to the cost of DVT, but enoxaparin remained cost-effective under various scenarios.
• Increased bleeding rates or costs did not significantly alter the overall financial outcomes favoring enoxaparin.

Conclusions:

• Enoxaparin is a cost-effective strategy for VTE prevention in trauma patients, potentially leading to savings.
• Concerns regarding enoxaparin's higher cost and bleeding risk should not deter its use for thromboprophylaxis in this population.
• Further research is recommended to confirm the efficacy of enoxaparin in trauma patients.