Comparing the Costs, Risks, and Benefits of Competing Strategies for the Primary Prevention of Venous Thromboembolism

Abstract

Abstract-Systematic cost-effectiveness analyses of regimens used for preventing venous thromboembolism (VTE) are becoming increasingly important for several reasons: the aging of the population, with an accompanying increase in admissions for orthopedic procedures or other surgery; expanded indications for thromboprophylaxis in nonsurgical patients; and the introduction of more expensive new agents that may increase safety and efficacy. At the same time, health care systems are under unprecedented pressure to contain the costs of care, particularly medications. Such economic analyses are made more difficult by the paucity of clinical trials comparing treatment regimens to one another rather than to placebo. Several methodological issues must be kept in mind when evaluating cost-effectiveness analyses of VTE prophylaxis. These include the perspective from which the analysis is performed (eg, the health care system as a whole versus a particular payer), limitations of trial data (eg, artificially short time horizons), and definition of outcomes (eg, flawed definition and grouping together of adverse effects or treatment failures). Quantifying costs across nations and health care systems is problematic as well. Another challenge is the extrapolation of efficacy data from highly monitored study patients to routine practice settings. Nevertheless, cost-effectiveness analyses of VTE treatments conducted in orthopedic surgery, trauma, general surgery, and acute medical settings can help define the relationships among expenditures, adverse outcomes, and patient benefit for particular therapeutic strategies in a variety of clinical situations. Key Words: venous thromboembolism Ⅲ cost-effectiveness Ⅲ prophylaxis Ⅲ low-molecular-weight heparin Ⅲ low-dose unfractionated heparin Ⅲ warfarin I n recent years, several factors have emerged that increase the importance of economic assessment of regimens used for the primary prevention of venous thromboembolism (VTE). For many decades, unfractionated heparin (UFH) and warfarin were the mainstays of treatment in this clinical setting. However, beginning in the 1990s and continuing to the present, new agents appeared that held the promise of greater efficacy and/or safety, albeit at greater financial cost. Moreover, new clinical and epidemiologic information emerged that stressed the importance of prophylaxis for VTE in a growing number of common clinical situations. These developments have occurred at the same time that health care systems throughout the world face unprecedented pressures to contain the costs of care. This has been particularly true for medications, which represent the fastest growing component of health care costs, rising between 13% and 19% annually in recent years. 1 Measuring the cost-effectiveness of medical interventions is a relatively new field; its methodologies are still evolving and are, on occasion, controversial. Nevertheless, consensus has developed over the appropriate broad approach to this discipline: given that an adequate evidence base of data fr...

Influence of Acquired and Genetic Risk Factors on the Prevention, Management, and Treatment of Thromboembolic Disease

“…American Heart Association statistics document two million cases of DVT each year with the incidence of DVT increasing as the population ages [1]. Pulmonary embolism (PE) accounts for 200 000 deaths each year and the annual cost of the treatment is measured in billions of dollars [2]. Postthrombotic syndrome is also a costly and morbid long term complication of DVT with severe adverse socioeconomic impacts [3].…”

Pathophysiology of Post-Thrombotic Syndrome: The Effect of Recurrent Venous Thrombosis and Inherited Thrombophilia

“…With its attendant mortality, PE is the most devastating complication of acute DVT. PE accounts for 200000 deaths each year in the United States (US), and the annual cost of the treatment is measured in billions of dollars [2,3].…”

Current practices in venous thromboembolism prophylaxis in otolaryngology–head and neck surgery

“…The primary means of preventing VTE is well known by providing patients with adequate prophylaxis, either mechanical or pharmacologic . Primary prophylaxis, the use of strategies to prevent the development of VTE in otherwise healthy patients, has been shown to reduce the incidence of VTE, reduce mortality, and ultimately reduce cost . However, the adoption of wide‐spread chemoprophylaxis in the postsurgical otolaryngology population has been slower than in other surgical specialties .…”