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To conduct a cost-utility evaluation of dabigatran etexilate compared with enoxaparin for the prevention of venous thromboembolism (VTE) after total knee replacement (TKR) and total hip replacement (THR) in Colombia. METHODS: An acute phase model, using decision analysis, and a long-term simulation Markov model were developed to compare the clinical outcomes, utilities, and direct medical costs of dabigatran 220 mg once daily and subcutaneous enoxaparin 40 mg once daily for VTE prophylaxis after TKR or THR. Time frame for the acute inpatient-phase was 14 days for TKR and 30 days for THR; adjustments for adverse events and average length of hospital stay were performed. The long-term simulation was performed using 6-months cycle transitions to eight health states for both TKR and THR. Transition probabilities for VTE and bleeding events were derived from Phase III studies comparing the two treatments. The probabilities of long-term events were estimated using data from published longitudinal studies. The payer perspective for a lifetime horizon was used. Sensitivity analyses were performed to assess the model robustness. The annual discount rate was set at 3.