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Venous thromboembolism prophylaxis in shoulder surgery: a break-even cost-effectiveness study
Brandon J Martinazzi1, Christopher M Stauch2, Peter F Monahan3
1Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA, USA.
Journal of Shoulder and Elbow Surgery
|November 9, 2023
Summary
Aspirin and enoxaparin are cost-effective for preventing venous thromboembolism (VTE) after shoulder surgery, with aspirin being cost-effective for all procedures and enoxaparin for specific ones. Further research is needed for optimal VTE prophylaxis strategies.
Area of Science:
- Orthopedic Surgery
- Pharmacoeconomics
- Vascular Medicine
Background:
- Venous thromboembolism (VTE) is a significant risk after orthopedic shoulder surgery.
- Limited research exists on the cost-effectiveness of VTE prophylaxis in this patient population.
Purpose of the Study:
- To determine the break-even cost-effectiveness of aspirin and enoxaparin for VTE prevention in patients undergoing shoulder surgery.
Main Methods:
- A break-even cost analysis was performed using drug retail prices and institutional costs for VTE treatment.
- VTE rates were obtained from the TriNetX national database for various shoulder procedures.
- Absolute risk reduction (ARR) was calculated to determine the number of patients needed to treat for cost-effectiveness.
Main Results:
- Aspirin (cost: $1.18) and enoxaparin (cost: $125.37) were analyzed against a VTE treatment cost of $9407.00.
- Aspirin broke even for all shoulder procedures at an ARR of 0.01%.
- Enoxaparin broke even for shoulder arthroplasty and hemiarthroplasty at an ARR of 1.33%, but not for arthroscopic rotator cuff repair at current prices.
Conclusions:
- Aspirin and enoxaparin achieve cost-effectiveness for VTE prophylaxis in shoulder arthroplasty and hemiarthroplasty under specific VTE rate reductions.
- For arthroscopic rotator cuff repair, only aspirin demonstrated cost-effectiveness at current market rates.
- Optimal VTE prophylaxis strategies require further investigation, especially for enoxaparin's cost-effectiveness in lower-risk procedures.
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