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Abstract
This paper examines the relative cost-effectiveness of enoxaparin and warfarin as
prophylactic therapy for the prevention of deep vein thrombosis (DVT) in patients
undergoing knee replacement surgery in a managed care setting. Although enoxaparin
is more expensive than warfarin, it is also more effective in the prevention of DVT
after knee replacement surgery. To date there has been no comprehensive assessment
of the cost-effectiveness of the alternative agents used for this purpose. This evaluation
is undertaken using a decision model that contrasts enoxaparin and warfarin regimens.
The model takes explicit account of the incidence of proximal DVT, distal DVT, pulmonary
embolism (PE), and major bleeds. The probabilities of clinical events are taken from
data from a published randomized, controlled, clinical trial. Key assumptions are
that PEs derive only from asymptomatic proximal DVTs and that a false-positive diagnosis
of DVT is made in 10% of cases. Unit resource cost data are taken from pharmacoeconomic
studies of DVT prophylaxis in hip replacement surgery. The analysis focuses on the
actual or expected cost of prophylactic treatment using enoxaparin as opposed to warfarin
and, as appropriate measures of cost-effectiveness, the cost per DVT event avoided
and the cost per incidence of PE avoided. The expected cost of warfarin prophylaxis
is $105 less per patient than that of enoxaparin. In terms of expected cost per DVT
event avoided, enoxaparin prophylaxis is $2525 less than for warfarin; in terms of
expected cost per PE avoided, it is $87,201 less. Enoxaparin is more cost-effective
than warfarin in terms of both DVT events and PEs avoided in patients who have undergone
knee replacement surgery.
Keywords
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© 1998 Published by Elsevier Inc.
