Dermatan sulfate versus unfractionated heparin for the prevention of venous thromboembolism in patients undergoing surgery for cancer - A cost-effectiveness analysis

Background: In a recent clinical trial, dermatan sulfate was found to be mo re effective than unfractionated heparin (UFH), but equally well tolerated, for the prevention of deep vein thrombosis (DVT) after major surgery for c ancer. Objective: To perform a cost-effectiveness analysis of dermatan sulfate ver sus UFH in this clinical setting. Design and setting: This was a retrospective economic analysis using data f rom a randomised clinical trial, and was performed from the hospital perspe ctive. Methods: Clinical event rates were extrapolated from the observed venograph ic DVT rates, using appropriate assumptions from the scientific literature. The economic effects of switching DVT prophylaxis from UFH to dermatan sul fate and the potential lives saved were assessed by a predictive decision m odel. Results: The per patient cost, including the burden of residual thromboembo lic events and major bleeding complications, was estimated to be 154 euros (EUR) for dermatan sulfate and EUR185 for UFH (1998 values). With reference to a potential target population of 60 000 patients/year undergoing surger y for cancer in Italy, the total prophylaxis-associated cost was EUP9 258 0 00 for dermatan sulfate and EUP11 096 000 for UFH, whereas the potential de aths from prophylaxis failure were 204 and 392, respectively. This represen ted a saving of EUR1 838 000 and 188 potential lives per year with the derm atan sulfate option. The final costs and effects were mainly sensitive to v ariations in the rates of DVT and pulmonary embolism, and to the possible n eed for 1 extra day of hospitalisation because of the earlier preoperative initiation of dermatan sulfate prophylaxis. Conclusion: dermatan sulfate is more cost effective than UFH for the preven tion of postoperative venous thromboembolism in patients with cancer. If th e hospital stay needs to be prolonged, then the dermatan sulfate option may involve a small additional cost (EUP47) per potential life saved.