Economic Analysis of Low-Dose Heparin vs the Low-Molecular-Weight Heparin Enoxaparin for Prevention of Venous Thromboembolism After Colorectal Surgery

Etchells, Edward; McLeod, Robin S.; Geerts, William; Barton, P.; Detsky, Allan S.

doi:10.1001/archinte.159.11.1221

Cited by 54 publications

(38 citation statements)

References 50 publications

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“…62 Four studies compared LMWH with LDUH in different surgical populations (colorectal, general, gynecologic, and abdominal surgery) within different health-care systems (Ontario, Canada; Germany; US Medicare). [63][64][65][66] In two of these studies, 63,65 total costs associated with LMWH treatment were marginally higher than those for LDUH. In contrast, in a study of general surgical patients in Germany, 64 LMWH was more effective than LDUH by 0.01 qualityadjusted life years (QALYs) and was less expensive by $160 per patient treated.…”

Section: Economic Evaluations Of Interventions For Thromboprophylaxismentioning

confidence: 92%

Prevention of VTE in Nonorthopedic Surgical Patients

Gould

García

Wren

et al. 2012

Chest

1,857

744

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(Grade 2C) prophylaxis be used other than early ambulation. For patients at low risk for VTE ( ‫ف‬ 1.5%), we suggest mechanical prophylaxis, preferably with intermittent pneumatic compression (IPC), over no prophylaxis (Grade 2C). For patients at moderate risk for VTE ( ‫ف‬ 3%) who are not at high risk for major bleeding complications, we suggest low-molecular-weight heparin (LMWH) (Grade 2B), low-dose unfractionated heparin (Grade 2B), or mechanical prophylaxis with IPC (Grade 2C) over no prophylaxis. For patients at high risk for VTE ( ‫ف‬ 6%) who are not at high risk for major bleeding complications, we recommend pharmacologic prophylaxis with LMWH (Grade 1B) or low-dose unfractionated heparin (Grade 1B) over no prophylaxis. In these patients, we suggest adding mechanical prophylaxis with elastic stockings or IPC to pharmacologic prophylaxis (Grade 2C). For patients at high risk for VTE undergoing abdominal or pelvic surgery for cancer, we recommend extended-duration, postoperative, pharmacologic prophylaxis (4 weeks) with LMWH over limited-duration prophylaxis (Grade 1B). For patients at moderate to high risk for VTE who are at high risk for major bleeding complications or those in whom the consequences of bleeding are believed to be particularly severe, we suggest use of mechanical prophylaxis, preferably with IPC, over no prophylaxis until the risk of bleeding diminishes and pharmacologic prophylaxis may be initiated (Grade 2C). For patients in all risk groups, we suggest that an inferior vena cava fi lter not be used for primary VTE prevention (Grade 2C) and that surveillance with venous compression ultrasonography should not be performed (Grade 2C). We developed similar recommendations for other nonorthopedic surgical populations. Conclusions: Optimal thromboprophylaxis in nonorthopedic surgical patients will consider the risks of VTE and bleeding complications as well as the values and preferences of individual patients. CHEST 2012; 141(2)(Suppl):e227S-e277SAbbreviations: CABG 5 coronary artery bypass graft; ES 5 elastic stockings; ICH 5 intracranial hemorrhage; IPC 5 intermittent pneumatic compression; IVC 5 inferior vena cava; LDUH 5 low-dose unfractionated heparin; LMWH 5 low-molecular-weight heparin; PE 5 pulmonary embolism; QALY 5 quality-adjusted life year; RR 5 risk ratio; VCU 5 venous compression ultrasonography

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Section: Economic Evaluations Of Interventions For Thromboprophylaxismentioning

confidence: 92%

Prevention of VTE in Nonorthopedic Surgical Patients

Gould

García

Wren

et al. 2012

Chest

1,857

744

View full text Add to dashboard Cite

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“…The studies reviewed herein are summarized in Table 2. [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] Some critical methodological considerations are briefly described below.…”

Section: Methodological Considerationsmentioning

confidence: 99%

“…13 Based on clinical trial data, Etchells et al assumed both prophylactic strategies had equal efficacy in preventing DVT and PE, whereas enoxaparin was assumed to have a 1.8-fold increased risk for major bleeding compared with low-dose UFH. The authors found that low-dose UFH was equally effective, safer, and less costly than enoxaparin.…”

Section: Other Surgerymentioning

confidence: 99%

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

Avorn

Winkelmayer

2004

Circulation

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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...

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“…Breast cancer death was allocated costs for palliative care. Costs for treatment of stroke, thromboembolic events, any cardiac event (myocardial infarction, angina), fracture, and endometrial cancer were obtained from published Canadian studies [28][29][30][31][32][33][34]36,45 . The treatment cost for arthralgia was based on the annual cost of anti-inflammatory medication (celecoxib 100 mg daily) 35 .…”

Section: Costsmentioning

confidence: 99%

Economic Evaluation of Hormonal Therapies for Postmenopausal Women with Estrogen Receptor–Positive Early Breast Cancer in Canada

et al. 2015

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Economic Analysis of Low-Dose Heparin vs the Low-Molecular-Weight Heparin Enoxaparin for Prevention of Venous Thromboembolism After Colorectal Surgery

Abstract: Although heparin and enoxaparin are equally effective, low-dose heparin is a more economically attractive choice for thromboembolism prophylaxis after colorectal surgery.

Cited by 54 publications

References 50 publications

Prevention of VTE in Nonorthopedic Surgical Patients

Prevention of VTE in Nonorthopedic Surgical Patients

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

Economic Evaluation of Hormonal Therapies for Postmenopausal Women with Estrogen Receptor–Positive Early Breast Cancer in Canada

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