Table 3.
Incremental costs, effects, and cost-efficacy ratios for the different modes of venous thromboembolism prophylaxis
| Low-molecular-weight heparins versus placebo | ||||||
|---|---|---|---|---|---|---|
| Reference | Patient population | Incremental cost (USD) | Incremental effects (VTE avoided or life-years or QALYS gained) | ICER (USD/VTE event avoided or life-years or QALYS gained) | Bleeding complications | Most economically attractive drug |
| *Pechevis, 2000 | Medical | Net saving (value not reported) per 1,000 patients with enoxaparin | 94 DVT/PE avoided, four lives (estimated 12 life-years) gained, per 1,000 patients with enoxaparin | Enoxaparin dominant | Not reported | Enoxaparin |
| Lloyd, 2001 | Medical | $20,680 per 1,000 patients with enoxaparin | 20 VTE events avoided per 1,000 patients with enoxaparin | $1, 034 per VTE avoided with enoxaparin | Six more major bleeding events per 1,000 patients with enoxaparin | Enoxaparin |
| *Lamy, 2002 | Medical | $1, 910 per 1,000 patients in tertiary care setting with enoxaparin | 2.3% fewer VTE events with enoxaparin | $83 per VTE avoided with enoxaparin | Not reported | Enoxaparin |
| *Offord, 2004 | Medical | Net saving ($26,478) per 1,000 patients with enoxaparin | 14 VTE events and 3.5 deaths avoided per 1,000 patients with enoxaparin | Enoxaparin dominant | Not reported | Enoxaparin |
| *Schaldich, 2006 | Medical | $44,665 per 1,000 patients with enoxaparin | 26 VTE events avoided per 1,000 patients with enoxaparin | $1, 711 per VTE avoided with enoxaparin | Not reported | Enoxaparin |
| Low-molecular-weight heparins versus unfractionated heparin | ||||||
| Reference | Patient population | Incremental cost (USD) | Incremental effects (VTE avoided or life-years or QALYS gained) | ICER (USD/VTE event avoided or life-years or QALYS gained) | Bleeding complications | Most economically attractive drug |
| *Drummond, 1994, enoxaparin | HFS | Net saving ($43,609) per 1,000 patients with enoxaparin | Four deaths avoided per 1,000 patients with enoxaparin | Enoxaparin dominant | Not reported | Enoxaparin |
| *Hawkins, 1997, enoxaparin | THR | $57,972 per 1,000 patients with enoxaparin | 47 DVT events avoided per 1,000 patients with enoxaparin | $1, 180 per VTE event avoided with enoxaparin | Not reported (implied enoxaparin increased bleeding risk) | Enoxaparin |
| Marchetti, 1999, enoxaparin | THR | Net saving ($90,000) per 1,000 patients with enoxaparin | 70 life-years gained per, 1000 patients with enoxaparin | Enoxaparin dominant | Not reported | Enoxaparin |
| *Etchells, 1999, enoxaparin | Colorectal surgery | $180,641 per 1,000 patients with enoxaparin | 0 VTE events avoided with enoxaparin | UFH dominant | 12 additional major bleeding events with enoxaparin | UFH |
| Lloyd, 2001, enoxaparin | Medical | Net saving ($850) per 1,000 patients with enoxaparin | 21 VTE events avoided per 1,000 patients with enoxaparin | Enoxaparin dominant | 18 fewer major bleeding events with Enoxaparin | Enoxaparin |
| *Offord, 2003, enoxaparin | Medical | Net saving ($54,649) per 1,000 patients with Enoxaparin | 20.5 VTE events and 0.5 deaths avoided per 1,000 patients with enoxaparin | Enoxaparin dominant | Not reported | Enoxaparin |
| *McGarry, 2004, enoxaparin | Medical | $14,459 per 1,000 patients with enoxaparin | 10 VTE events and 4.4 deaths avoided per 1,000 patients with enoxaparin | $1, 445 per VTE event avoided, and $10,360 per death avoided with enoxaparin | 2.7% fewer bleeding events, 0.9% fewer episodes of HIT | Enoxaparin |
| *Schadlich, 2006, enoxaparin | Medical | Net saving ($46,499) per 1,000 patients with Enoxaparin | N/R | Enoxaparin dominant | 7.7 fewer major bleeding episodes with enoxaparin | Enoxaparin |
| *Deitelzweig, 2008 | Medical | Net saving ($339,361) per 1,000 patients with enoxaparin | 11 VTE events, three deaths avoided per 1,000 patients with enoxaparin | Enoxaparin dominant | Five major bleeding events, four episodes of HIT avoided per 1,000 patients with enoxaparin | Enoxaparin |
| Wade, 2008, enoxaparin | Gynecology oncology Surgery | Net saving ($36,197) per 1,000 patients with enoxaparin | Eight DVTs, 18 PE events avoided per 1,000 patients with enoxaparin | Enoxaparin dominant | 21 additional major bleeding events per 1,000 patients with enoxaparin | Enoxaparin |
| *Lloyd, 1997, nadroparin | Orthopedics | Net savings ($192,000) per 1,000 patients with enoxaparin | 50 VTE events avoided per 1,000 patients with enoxaparin | Enoxaparin dominant | Not reported | Nadroparin |
| General surgery | Net savings ($33,000) per 1,000 patients with enoxaparin | Nine VTE events avoided per 1,000 patients with enoxaparin | Nadroparin dominant | Not reported | Nadroparin | |
| Heerey, 2005, dalteparin | General surgery | $473,000 per 1,000 patients with dalteparin | 21 QALYs per 1,000 patients with dalteparin | $20,337/QALY gained with dalteparin | Not reported | Dalteparin |
| Low-molecular-weight heparins versus warfarin | ||||||
| Reference | Patient population | Incremental cost (USD) | Incremental effects (VTE avoided or life-years or QALYS gained) | ICER (USD/VTE event avoided or life-years or QALYS gained) | Bleeding complications | Most economically attractive drug |
| *O'Brien, 1994, enoxaparin | THR | $133,571 per 1,000 patients with LMWH | Five VTE events, 0.4 deaths avoided per 1,000 patients with LMWH | $26,711 per VTE event avoided, $334,055 per death avoided, $32,158 per life-year gained with LMWH | Not reported | LMWH |
| *Menzin, 1995, enoxaparin | THR | $69,659 per 1,000 patients with LMWH | 20.1 VTE events and 4.3 deaths avoided per 1,000 patients with LMWH | $3,466 per VTE avoided, $16,200 per additional death avoided | Not reported | LMWH |
| *Hull, 1997, tinzaparin | TKR, THR | Net saving ($52,690) per 1,000 patients with LMWH | 60 VTE events avoided per 1,000 patients with LMWH | LMWH dominant | 2.2% increase in major bleeding events with LMWH | LMWH |
| *Hawkins, 1998, enoxaparin | TKR | $126,766 per 1,000 patients with LMWH | 145 VTE events avoided per 1,000 patients with LMWH | $874 per VTE event avoided with LMWH | 0.3% increased risk of major bleeding event with LMWH | LMWH |
| *Francis, 1999 | THR | Net saving ($153,000) per 1,000 patients treated with LMWH | 112 VTE events avoided per 1,000 patients with LMWH | LMWH dominant | 62 more patients with bleeding event with LMWH | LMWH |
| *Botteman, 2002, enoxaparin | THR | $154,000 per 1,000 patients with LMWH | 77 DVTs avoided per 1,000 patients, 40 QALYs gained per 1,000 patients with LMWH | $2013 per DVT avoided, $40,169 per death avoided, $4349 per QALY gained with LMWH | Not reported | LMWH |
| Nerurkar, 2002, enoxaparin | TKR | Net saving ($1, 054,000) per 1,000 patients with LMWH | Seven deaths avoided per 1,000 patients with LMWH | LMWH dominant | Not reported | LMWH |
| *Caprini, 2002 | THR | $110,235 per 1,000 patients with LMWH | 5.8 VTE events avoided per 1,000 patients with LMWH | $19,006 per VTE event avoided with LMWH | Not reported | LMWH |
| Comparison of low-molecular-weight heparins and other agents | ||||||
| Reference | Patient population | Incremental cost (USD) | Incremental effects (VTE avoided or life-years or QALYS gained) | ICER (USD/VTE event avoided or life-years or QALYS gained) | Bleeding complications | Most economically attractive drug |
| Levin, 2001, desirudin versus enoxaparin | THR | $72,000 per 1,000 patients | 19.1 life-years gained per 1,000 patients with desirudin | $3,794 per life-year gained | Not reported | Desirudin |
| *Honorato, 2004, bemiparin versus enoxaparin | TKR | Net savings ($227,000) per 1,000 patients with bemiparin | 42 VTE events avoided per 1,000 patients with bemiparin | Bemiparin dominant | Not reported | Bemiparin |
| *Attanasio, 2001, dermatan sulfate versus UFH 5,000 U, 3 times daily | Surgical cancer | Net saving ($53,000) per 1,000 patients with dermatan sulfate | 70 DVTs avoided and 3.1 lives gained per 1,000 patients with dermatan sulfate | Dermatan sulfate dominant | Five additional major bleeding events with dermatan sulfate | Dermatan sulfate |
| Heerey, 2005, dalteparin 2,500 U versus dalteparin, 5,000 U | Abdominal surgery | $477,000 per 1,000 patients with dalteparin | 18 QALYs per 1,000 patients with dalteparin | $24,357/QALY gained with dalteparin | Not reported | Dalteparin 5,000 U |
| Wade, 2001, tinzaparin versus enoxaparin | Spinal cord injury | $223,259 per 1,000 patients with enoxaparin | Not reported | Not reported | Not reported | Not reported |
| Fondaparinux versus enoxaparin | ||||||
| Reference | Patient population | Incremental cost (USD) | Incremental effects (VTE avoided or life-years or QALYS gained) | ICER (USD/VTE event avoided or life-years or QALYS gained) | Bleeding complications | Most economically attractive drug |
| *Gordois, 2003 | THR, TKR, HFS | $10,000 per 1,000 patients by discharge from hospital with fondaparinux | 11 VTE events, 1.9 deaths avoided per 1,000 patients by discharge from hospital with fondaparinux | $1, 077 per VTE event avoided and $5,317 per death avoided with fondaparinux | Not reported | Fondaparinux |
| *Lundkvist, 2003 | THR, TKR, HFS | Net saving ($59,000) per 1,000 patients with fondaparinux | 17.9 VTE events, 2.6 deaths avoided per 1,000 patients (average among three conditions) with fondaparinux | Fondaparinux dominant | Not reported | Fondaparinux |
| Wade, 2003, enoxaparin, 30 mg twice daily enoxaparin, 40 mg once daily | THR | Net savings ($168,382) per 1,000 patients with enoxaparin | Three VTE events per 1,000 patients with enoxaparin | Enoxaparin dominant | 27 more bleeding episodes per 1,000 patients with fondaparinux compared with twice-daily enoxaparin Six more bleeding episodes per 1,000 patients with enoxaparin once daily compared with fondaparinux | Enoxaparin twice daily |
| Annemans, 2004 | THR, TKR, HFS | $2,800 per 1,000 patients with fondaparinux | 17.7 VTE events per 1,000 patients with fondaparinux | $158 per VTE event avoided; $104 per death avoided with fondaparinux | 1.6 more bleeding episodes per 1,000 patients with fondaparinux | Fondaparinux |
| *Dranitsaris, 2004 | THR, TKR, HFS | Net saving ($50,000) per 1,000 patients with fondaparinux | 16 VTE avoided per 1,000 patients with fondaparinux | Fondaparinux dominant | 10 more major bleeding events per 1,000 patients with fondaparinux | Fondaparinux |
| Spruill, 2004 | TKR (2002 USD) | Net saving ($43,549) per 1,000 patients with fondaparinux | 36 VTE events avoided per 1,000 patients with fondaparinux | Fondaparinux dominant | 10 more major bleeds and three more minor bleeding events per 1,000 patients with fondaparinux | Fondaparinux |
| Spruill, 2004 | THR (2002 USD) | Net saving ($18,898) per 1,000 patients with fondaparinux | 20 VTE events avoided per 1,000 patients with fondaparinux | Fondaparinux Dominant | 19 more major bleeding events per 1,000 patients with fondaparinux | Fondaparinux |
| Wade, 2004 | HFS | $21,171 per 1,000 patients with fondaparinux | 34 VTE events avoided per 1,000 patients with fondaparinux | $623 per VTE avoided, $32,144 per QALY gained with fondaparinux | Approximately 20% increased bleeding costs for fondaparinux | Fondaparinux |
| *Sullivan, 2004 | THR, TKR, HFS | Net savings ($67,000) per 1,000 patients treated with fondaparinux | 3.7 VTE events avoided per 1,000 patients with Fondaparinux | Fondaparinux dominant | Two more bleeding events per 1000 patients with Fondaparinux | Fondaparinux |
| *Szucs, 2005 | THR, TKR, HFS | Net savings ($18,153) per 1,000 patients treated with fondaparinux | 8.1 VTE events avoided per 1,000 patients with fondaparinux | Fondaparinux dominant | 1.6 more bleeding events per 1,000 patients with fondaparinux | Fondaparinux |
| *Bjorvatn, 2005 | THR, TKR, HFS | $53,553 per 1,000 patients treated with fondaparinux | 7.2 VTE events avoided per 1,000 patients with fondaparinux | $753 per VTE avoided, $6,782 per death avoided with fondaparinux | Two more bleeding events per 1,000 patients treated with fondaparinux | Fondaparinux |
| Dabigatran versus rivaroxaban and low-molecular-weight heparins | ||||||
| Wolowacz, 2009 | THR | THR Net savings ($103,050) per 1,000 patients treated with dabigatran | Two VTEs avoided, eight life-years, six QALYs gained per 1,000 patients treated with dabigatran | Dabigatran dominant | Five additional major bleeding events, two episodes HIT avoided per 1,000 patients treated with dabigatran | Dabigatran |
| TKR | Net savings ($8,162) per 1,000 patients treated with dabigatran | Four VTEs avoided, 9 life-years, 7 QALYs gained per 1,000 patients treated with dabigatran | Dabigatran dominant | Six additional major bleeding events, two episodes HIT avoided per 1,000 patients treated with dabigatran | ||
| McCullagh, 2009 | THR | Net savings ($24,104) per 1,000 patients treated with rivaroxaban | 7 Life-years, 10 QALYs gained per 1,000 patients with rivaroxaban | Rivaroxaban dominant | Not reported | Rivaroxaban |
| TKR | Net savings ($213,452) per 1,000 patients treated with rivaroxaban | 7 Life-years, 12 QALYs gained per 1,000 patients with rivaroxaban | Rivaroxaban dominant | |||
HFS, hip-fracture surgery; ICER, incremental cost-efficacy ratio; LMWH, low-molecular-weight heparin; THR, total hip replacement; UFH, unfractionated heparin; USD, United States dollars; VTE, venous thromboembolism. *Industry-sponsored study.