Table 7.
Base case probabilistic analysis results for A) Elective total hip replacement B) Elective total knee replacement.
| Intervention | Mean discounted QALYs (95% CI) | Mean Discounted Costs (95% CI) | Incremental QALYs vs. LMWH+ AES (95% CI) | Incremental costs vs. LMWH+ AES (95% CI) | Mean INMB at £20K per QALY (95% CI) | Probability most CE at £20k (a) | Rank at £20k (95% CI) (b) |
|---|---|---|---|---|---|---|---|
| Elective total hip replacement (eTHR) | |||||||
| LMWH (std,std) + AES (c) | 10.28 (8.01 to 11.98) |
£489 (£350 to £832) |
0.000 (0.000 to 0.000) |
£0 (£0 to £0) |
£0 (£0 to £0) |
0.1% | 4 (3, 11) |
| LMWH (std,extd)+ AES | 10.29 (8.02 to 12.00) |
£706 (£509 to £1,376) |
0.013 (−0.004 to 0.030) |
£217 (–£42 to £694) |
£36 (–£745 to £484) |
0.6% | 2 (2, 12) |
| Fondaparinux+ AES | 10.26 (7.98 to 11.96) |
£665 (£336 to £1,563) |
−0.015 (−0.112 to 0.013) |
£176 (–£92 to £800) |
–£478 (–£2,618 to £278) |
0.2% | 6 (3, 15) |
| Foot pump + AES | 10.24 (7.99 to 11.94) |
£445 (£209 to £926) |
−0.036 (−0.182 to 0.012) |
–£44 (–£329 to £398) |
–£684 (–£3,930 to £478) |
0.6% | 9 (2, 15) |
| IPCD | 10.16 (7.86 to 11.91) |
£742 (£255 to £1,968) |
−0.115 (−0.681 to 0.011) |
£253 (–£246 to £1,455) |
–£2,550 (–£14,733 to £396) |
0.1% | 12 (4, 15) |
| AES (above knee) | 10.04 (7.35 to 11.93) |
£691 (£119 to £3,765) |
−0.234 (−2.197 to 0.027) |
£202 (–£424 to £3,310) |
–£4,873 (–£46,725 to £861) |
13.2% | 14 (1, 16) |
| Foot pump | 9.80 (6.96 to 11.77) |
£1,150 (£161 to £4,054) |
−0.472 (−2.681 to 0.015) |
£661 (–£344 to £3,578) |
–£10,104 (–£57,043 to £590) |
1.4% | 15 (2, 16) |
| AES | 10.27 (8.01 to 11.97) |
£299 (£102 to £793) |
−0.009 (−0.103 to 0.022) |
–£189 (–£460 to £261) |
£5 (–£2,106 to £781) |
8.4% | 3 (1, 14) |
| LMWH (std,std) | 10.23 (7.95 to 11.94) |
£691 (£375 to £1,413) |
−0.048 (−0.283 to 0.009) |
£202 (–£44 to £767) |
–£1,162 (–£6,266 to £197) |
0.0% | 10 (6, 13) |
| LMWH (std,extd) | 10.27 (7.98 to 11.98) |
£844 (£528 to £1,582) |
0.000 (−0.070 to 0.025) |
£356 (£24 to £954) |
–£361 (–£2,042 to £349) |
0.1% | 5 (4, 13) |
| Aspirin (low dose, std duration) | 9.42 (6.50 to 11.59) |
£1,687 (£157 to £4,039) |
−0.856 (−3.179 to 0.009) |
£1,198 (–£390 to £3,610) |
–£18,312 (–£66,988 to £479) |
0.7% | 16 (2, 16) |
| LMWH (std, std) + Aspirin (extd duration) | 10.29 (8.02 to 12.00) |
£311 (£148 to £1437) |
0.018 (0.003 to 0.036) |
–£178 (–£548 to £781) |
£530 (–£784 to £1,103) |
72.0% | 1 (1, 11) |
| Dabigatran | 10.20 (7.93 to 11.94) |
£849 (£319 to £1,957) |
−0.077 (−0.465 to 0.010) |
£360 (–£122 to £1,331) |
–£1,903 (–£10,144 to £254) |
0.0% | 11 (5, 15) |
| Apixaban | 10.25 (7.96 to 11.97) |
£497 (£163 to £1,588) |
−0.030 (−0.270 to 0.022) |
£8 (–£302 to £895) |
–£598 (–£6,089 to £632) |
2.2% | 8 (2, 14) |
| Rivaroxaban | 10.25 (7.97 to 11.97) |
£606 (£227 to £1,452) |
−0.021 (−0.190 to 0.019) |
£117 (–£234 to £814) |
–£529 (–£4,385 to £514) |
0.4% | 7 (2, 13) |
| No prophylaxis | 10.08 (7.80 to 11.82) |
£908 (£297 to £2,185) |
−0.196 (−0.885 to −0.008) |
£419 (–£195 to £1,677) |
–£4,336 (–£19,297 to –£95) |
0.0% | 13 (10, 16) |
| Elective total knee replacement (eTKR) | |||||||
| LMWH (std,std) + AES (c) | 9.81 (7.86 to 11.58) |
£448 (£364 to £613) |
0.000 (0.000 to 0.000) |
£0 (£0 to £0) |
£0 (£0 to £0) |
0.1% | 4 (4, 12) |
| Fondaparinux+ AES | 9.75 (7.83 to 11.52) |
£904 (£358 to £3016) |
−0.054 (−0.183 to −0.009) |
£457 (–£53 to £2466) |
–£1,532 (–£6,183 to –£176) |
0.0% | 11 (6, 13) |
| Foot pump + AES | 9.80 (7.86 to 11.58) |
£315 (£208 to £590) |
−0.003 (−0.020 to 0.006) |
–£132 (–£234 to £32) |
£72 (–£379 to £343) |
0.1% | 3 (3, 12) |
| IPCD | 9.78 (7.82 to 11.56) |
£332 (£133 to £1246) |
−0.029 (−0.367 to 0.019) |
–£115 (–£304 to £698) |
–£473 (–£8,223 to £635) |
5.8% | 7 (1, 13) |
| Foot pump | 9.81 (7.86 to 11.58) |
£219 (£119 to £473) |
0.006 (−0.011 to 0.018) |
–£228 (–£332 to –£65) |
£353 (–£101 to £665) |
18.1% | 1 (1, 10) |
| AES | 9.76 (7.77 to 11.57) |
£387 (£167 to £1397) |
−0.043 (−0.420 to 0.014) |
–£60 (–£271 to £876) |
–£803 (–£9,251 to £520) |
0.2% | 9 (3, 13) |
| LMWH (std,std) | 9.77 (7.79 to 11.55) |
£468 (£287 to £1563) |
−0.035 (−0.441 to 0.018) |
£21 (–£105 to £989) |
–£728 (–£10,057 to £445) |
0.0% | 8 (4, 11) |
| LMWH (std,extd) | 9.80 (7.85 to 11.58) |
£666 (£508 to £1302) |
−0.009 (−0.111 to 0.023) |
£218 (£34 to £832) |
–£398 (–£3,013 to £397) |
0.1% | 6 (3, 12) |
| Aspirin (low dose, std duration) | 9.81 (7.86 to 11.58) |
£187 (£118 to £304) |
0.001 (−0.018 to 0.014) |
–£260 (–£436 to –£125) |
£281 (–£195 to £703) |
9.0% | 2 (1, 12) |
| Dabigatran | 9.71 (7.53 to 11.56) |
£406 (£100 to £2987) |
−0.101 (−1.308 to 0.020) |
–£42 (–£343 to £2524) |
–£1,977 (–£28,720 to £707) |
3.6% | 13 (1, 13) |
| Apixaban | 9.73 (7.62 to 11.54) |
£322 (£69 to £2624) |
−0.081 (−1.178 to 0.023) |
–£125 (–£392 to £2166) |
–£1,504 (–£25,838 to £802) |
42.8% | 10 (1, 13) |
| Rivaroxaban | 9.78 (7.79 to 11.57) |
£256 (£82 to £1205) |
−0.025 (−0.333 to 0.021) |
–£191 (–£360 to £634) |
–£306 (–£6,975 to £747) |
19.7% | 5 (1, 11) |
| No prophylaxis | 9.73 (7.68 to 11.53) |
£453 (£137 to £2281) |
−0.082 (−0.894 to 0.014) |
£6 (–£298 to £1,715) |
–£1,655 (–£20,058 to £540) |
0.4% | 12 (3, 13) |
a AES, anti-embolism stockings; CE, cost effective; CI, confidence interval; extd, extended; IPCD, intermittent pneumatic compression devices; INMB, incremental net monetary benefit; LMWH, low molecular weight heparin; QALYs, quality-adjusted life-years; std, standard.
Calculated at cost effectiveness threshold of £20,000 per QALY gained. b The rank is calculated based on the INMB. The intervention with the highest INMB is ranked first, The 95% CI has been calculated probabilistically. C Model comparator.