Gk. Bell et Sz. Goldhaber, Cost implications of low molecular weight heparins as prophylaxis following total hip and knee replacement, VASC MED, 6(1), 2001, pp. 23-29
Deep venous thrombosis (DVT) and pulmonary embolism (PE) are serious and co
stly complications of total hip and knee replacement surgery. The risk of t
hese complications is significantly reduced by prophylaxis. Low molecular w
eight heparins (LMWH) are being used for this indication with increased fre
quency. The objective of this study was to assess the cost implications of
LMWH for the prevention of symptomatic DVT and PE complications following t
otal hip and knee replacement surgery. The study design was cost analysis b
ased on utilization and the costs of medical resources for prophylaxis and
treatment of DVT/PE. A retrospective hospital data set was used to assess s
ymptomatic DVT/PE complication rates and medical resource utilization in pa
tients receiving warfarin, other, and no prophylaxis. The results of a clin
ical trial were used to estimate relative reductions in risk of symptomatic
DVT/PE due to prophylaxis with LMWH. The 7721 total hip and knee replaceme
nt patients analyzed were admitted in 1992 in 57 acute-care non-federal hos
pitals. The measurements were of incremental costs or charges expected to b
e saved as a result of using LMWH prophylaxis instead of warfarin prophylax
is. Prophylaxis using LMWH rather than warfarin reduces the expected total
costs (charges) of treatment by $50 ($193), not including the pharmaceutica
l costs associated with prophylaxis. The cost reduction in favor of LMWH wa
s sensitive to several factors, including blood monitoring costs and DVT/PE
complication rates. Where a reduction of one day in hospital stay could be
realized from LMWH's early onset of action, the cost (charges) reduction i
ncreased to $226($624). In conclusion, LMWH has the potential to offer seve
ral short- and long-term cost advantages compared with warfarin, mostly due
to lower test costs associated with prophylaxis and reduced complication r
ates.