Deep vein thrombosis and pulmonary embolism are major risks in patients exp
eriencing major trauma. Currently, the American College of Chest Physicians
recommends low molecular weight heparin as prophylaxis in trauma patients
with identifiable risk factors in the absence of contraindications. Enoxapa
rin is the only low molecular weight heparin available in the US that has b
een evaluated to date in this indication. The purpose of this study was to
perform incremental cost-effectiveness ratio calculations for enoxaparin ve
rsus no prophylaxis as thromboembolic prophylaxis in trauma patients. These
calculations demonstrate that a cost of $279.43 would be incurred for each
thromboembolic event avoided if enoxaparin 30 mg every 12 h were routinely
used as prophylaxis in this population, compared with no prophylaxis. Sens
itivity analyses demonstrate that if the incidence of proximal vein thrombo
sis in patients prophylaxed with enoxaparin approached 1.8%, if the actual
rate of these thrombi exceeded 19.4% in untreated patients, or if the cost
of the drug was decreased to $15.25 per dose, a cost saving would be experi
enced in routine prophylaxis with this agent. (C) 2000 Lippincott Williams
& Wilkins.