Cost effectiveness of desirudin compared with a low molecular weight heparin in the prevention of deep vein thrombosis after total hip replacement surgery

Objectives: This prospective pharmacoeconomic study analyses and discusses the cost effectiveness (expressed as cost per life-year gained) of desirudi n in comparison with a low molecular weight heparin (LMWH), enoxaparin, as prophylaxis against deep vein thrombosis (DVT) in total hip replacement. Methods: The cost effectiveness was analysed on the basis of results from a clinical trial that compared the recombinant hirudin, desirudin, with the LMWH, enoxaparin. The trial results regarding the incidence of DVT are incl uded together with epidemiological data in a decision tree, simulating long term cost effectiveness of patients undergoing elective hip replacement. T he model includes Markov processes simulating patients up to the age of 85 years, including the costs of DVT-related long term complications. Results: The average total thrombosis-related cost per patient under prophy lactic therapy with enoxaparin is 7022 Swedish kronor (SEK) compared with S EK7497 when using desirudin (1998 values). The total costs with desirudin a re 7% higher. Prophylaxis with desirudin in those patients undergoing elect ive hip replacement surgery adds, on average, 7 days of life per patient wh en compared with treatment using enoxaparin. This is equivalent to 1.91 add itional years of life per 100 patients treated. The incremental cost-effect iveness ratio of prophylaxis with desirudin in patients undergoing elective hip replacement surgery is SEK24 864 per life-year gained in comparison wi th enoxaparin. Conclusion: The present study demonstrates that prophylactic therapy with d esirudin is a cost-effective approach for the prevention of DVT in patients undergoing total hip replacement.