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Cost-effectiveness of prophylaxis in total hip replacement
G D Paiement1, S J Wessinger, W H Harris
1Division of Orthopedics, University of Montreal Medical School, Quebec, Canada.
American Journal of Surgery
|April 1, 1991
Summary
Low-dose warfarin with clinical surveillance significantly cuts fatal pulmonary embolism (PE) and costs for hip replacement patients. This cost-effective strategy is recommended for routine use, reducing PE incidence and healthcare expenses.
Area of Science:
- Medical Economics
- Preventive Medicine
- Thrombosis Management
Background:
- Venous thromboembolic disease (VTE) poses significant risks, including fatal pulmonary embolism (PE), for patients undergoing elective total hip replacement (THR).
- Effective and cost-efficient prophylactic strategies are crucial for managing VTE in this patient population.
Purpose of the Study:
- To perform a theoretical cost-effectiveness analysis of seven VTE management strategies in patients over 39 undergoing elective THR.
- To evaluate strategies based on lives saved (reduction in fatal PE) and economic impact (prevention and treatment costs).
Main Methods:
- Theoretical analysis comparing seven distinct management strategies for VTE.
- Evaluation metrics included incidence of fatal PE and associated healthcare charges per 1,000 patients.
- Analysis focused on patients over 39 undergoing elective total hip replacement.
Main Results:
- Low-dose warfarin combined with clinical surveillance reduced fatal PE from 20 to 4 per 1,000 patients and costs from $550,000 to $400,000 per 1,000 patients.
- Adding routine venography or duplex sonography to warfarin prophylaxis further reduced fatal PE but incurred substantial additional costs per life saved ($200,000 for venography, $50,000 for sonography).
- Low-dose warfarin with routine sonography was cost-neutral compared to no prophylaxis/screening, drastically reducing fatal PE from 20 to 0.3 per 1,000 patients.
Conclusions:
- Low-dose warfarin prophylaxis combined with clinical surveillance is a highly cost-effective strategy for reducing fatal PE in THR patients.
- Routine sonography alongside low-dose warfarin offers significant PE reduction with comparable costs to no prophylaxis.
- For settings lacking duplex sonography, a 12-week postoperative course of low-dose warfarin without routine screening is an effective and cost-efficient alternative.