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Table 3 Incremental costs, effects, and cost-efficacy ratios for the different modes of venous thromboembolism prophylaxis

From: Economic analyses of venous thromboembolism prevention strategies in hospitalized patients: a systematic review

Low-molecular-weight heparins versus placebo

Reference

Patient population

Incremental cost (USD)

Incremental effects (VTE avoided or life-years or QALYS gained)

ICER (USD/VTE event avoided or life-years or QALYS gained)

Bleeding complications

Most economically attractive drug

*Pechevis, 2000

Medical

Net saving (value not reported) per 1,000 patients with enoxaparin

94 DVT/PE avoided, four lives (estimated 12 life-years) gained, per 1,000 patients with enoxaparin

Enoxaparin dominant

Not reported

Enoxaparin

Lloyd, 2001

Medical

$20,680 per 1,000 patients with enoxaparin

20 VTE events avoided per 1,000 patients with enoxaparin

$1, 034 per VTE avoided with enoxaparin

Six more major bleeding events per 1,000 patients with enoxaparin

Enoxaparin

*Lamy, 2002

Medical

$1, 910 per 1,000 patients in tertiary care setting with enoxaparin

2.3% fewer VTE events with enoxaparin

$83 per VTE avoided with enoxaparin

Not reported

Enoxaparin

*Offord, 2004

Medical

Net saving ($26,478) per 1,000 patients with enoxaparin

14 VTE events and 3.5 deaths avoided per 1,000 patients with enoxaparin

Enoxaparin dominant

Not reported

Enoxaparin

*Schaldich, 2006

Medical

$44,665 per 1,000 patients with enoxaparin

26 VTE events avoided per 1,000 patients with enoxaparin

$1, 711 per VTE avoided with enoxaparin

Not reported

Enoxaparin

Low-molecular-weight heparins versus unfractionated heparin

Reference

Patient population

Incremental cost (USD)

Incremental effects (VTE avoided or life-years or QALYS gained)

ICER (USD/VTE event avoided or life-years or QALYS gained)

Bleeding complications

Most economically attractive drug

*Drummond, 1994, enoxaparin

HFS

Net saving ($43,609) per 1,000 patients with enoxaparin

Four deaths avoided per 1,000 patients with enoxaparin

Enoxaparin dominant

Not reported

Enoxaparin

*Hawkins, 1997, enoxaparin

THR

$57,972 per 1,000 patients with enoxaparin

47 DVT events avoided per 1,000 patients with enoxaparin

$1, 180 per VTE event avoided with enoxaparin

Not reported (implied enoxaparin increased bleeding risk)

Enoxaparin

Marchetti, 1999, enoxaparin

THR

Net saving ($90,000) per 1,000 patients with enoxaparin

70 life-years gained per, 1000 patients with enoxaparin

Enoxaparin dominant

Not reported

Enoxaparin

*Etchells, 1999, enoxaparin

Colorectal surgery

$180,641 per 1,000 patients with enoxaparin

0 VTE events avoided with enoxaparin

UFH dominant

12 additional major bleeding events with enoxaparin

UFH

Lloyd, 2001, enoxaparin

Medical

Net saving ($850) per 1,000 patients with enoxaparin

21 VTE events avoided per 1,000 patients with enoxaparin

Enoxaparin dominant

18 fewer major bleeding events with Enoxaparin

Enoxaparin

*Offord, 2003, enoxaparin

Medical

Net saving ($54,649) per 1,000 patients with Enoxaparin

20.5 VTE events and 0.5 deaths avoided per 1,000 patients with enoxaparin

Enoxaparin dominant

Not reported

Enoxaparin

*McGarry, 2004, enoxaparin

Medical

$14,459 per 1,000 patients with enoxaparin

10 VTE events and 4.4 deaths avoided per 1,000 patients with enoxaparin

$1, 445 per VTE event avoided, and $10,360 per death avoided with enoxaparin

2.7% fewer bleeding events, 0.9% fewer episodes of HIT

Enoxaparin

*Schadlich, 2006, enoxaparin

Medical

Net saving ($46,499) per 1,000 patients with Enoxaparin

N/R

Enoxaparin dominant

7.7 fewer major bleeding episodes with enoxaparin

Enoxaparin

*Deitelzweig, 2008

Medical

Net saving ($339,361) per 1,000 patients with enoxaparin

11 VTE events, three deaths avoided per 1,000 patients with enoxaparin

Enoxaparin dominant

Five major bleeding events, four episodes of HIT avoided per 1,000 patients with enoxaparin

Enoxaparin

Wade, 2008, enoxaparin

Gynecology oncology Surgery

Net saving ($36,197) per 1,000 patients with enoxaparin

Eight DVTs, 18 PE events avoided per 1,000 patients with enoxaparin

Enoxaparin dominant

21 additional major bleeding events per 1,000 patients with enoxaparin

Enoxaparin

*Lloyd, 1997, nadroparin

Orthopedics

Net savings ($192,000) per 1,000 patients with enoxaparin

50 VTE events avoided per 1,000 patients with enoxaparin

Enoxaparin dominant

Not reported

Nadroparin

 

General surgery

Net savings ($33,000) per 1,000 patients with enoxaparin

Nine VTE events avoided per 1,000 patients with enoxaparin

Nadroparin dominant

Not reported

Nadroparin

Heerey, 2005, dalteparin

General surgery

$473,000 per 1,000 patients with dalteparin

21 QALYs per 1,000 patients with dalteparin

$20,337/QALY gained with dalteparin

Not reported

Dalteparin

Low-molecular-weight heparins versus warfarin

Reference

Patient population

Incremental cost (USD)

Incremental effects (VTE avoided or life-years or QALYS gained)

ICER (USD/VTE event avoided or life-years or QALYS gained)

Bleeding complications

Most economically attractive drug

*O'Brien, 1994, enoxaparin

THR

$133,571 per 1,000 patients with LMWH

Five VTE events, 0.4 deaths avoided per 1,000 patients with LMWH

$26,711 per VTE event avoided, $334,055 per death avoided, $32,158 per life-year gained with LMWH

Not reported

LMWH

*Menzin, 1995, enoxaparin

THR

$69,659 per 1,000 patients with LMWH

20.1 VTE events and 4.3 deaths avoided per 1,000 patients with LMWH

$3,466 per VTE avoided, $16,200 per additional death avoided

Not reported

LMWH

*Hull, 1997, tinzaparin

TKR, THR

Net saving ($52,690) per 1,000 patients with LMWH

60 VTE events avoided per 1,000 patients with LMWH

LMWH dominant

2.2% increase in major bleeding events with LMWH

LMWH

*Hawkins, 1998, enoxaparin

TKR

$126,766 per 1,000 patients with LMWH

145 VTE events avoided per 1,000 patients with LMWH

$874 per VTE event avoided with LMWH

0.3% increased risk of major bleeding event with LMWH

LMWH

*Francis, 1999

THR

Net saving ($153,000) per 1,000 patients treated with LMWH

112 VTE events avoided per 1,000 patients with LMWH

LMWH dominant

62 more patients with bleeding event with LMWH

LMWH

*Botteman, 2002, enoxaparin

THR

$154,000 per 1,000 patients with LMWH

77 DVTs avoided per 1,000 patients, 40 QALYs gained per 1,000 patients with LMWH

$2013 per DVT avoided, $40,169 per death avoided, $4349 per QALY gained with LMWH

Not reported

LMWH

Nerurkar, 2002, enoxaparin

TKR

Net saving ($1, 054,000) per 1,000 patients with LMWH

Seven deaths avoided per 1,000 patients with LMWH

LMWH dominant

Not reported

LMWH

*Caprini, 2002

THR

$110,235 per 1,000 patients with LMWH

5.8 VTE events avoided per 1,000 patients with LMWH

$19,006 per VTE event avoided with LMWH

Not reported

LMWH

Comparison of low-molecular-weight heparins and other agents

Reference

Patient population

Incremental cost (USD)

Incremental effects (VTE avoided or life-years or QALYS gained)

ICER (USD/VTE event avoided or life-years or QALYS gained)

Bleeding complications

Most economically attractive drug

Levin, 2001, desirudin versus enoxaparin

THR

$72,000 per 1,000 patients

19.1 life-years gained per 1,000 patients with desirudin

$3,794 per life-year gained

Not reported

Desirudin

*Honorato, 2004, bemiparin versus enoxaparin

TKR

Net savings ($227,000) per 1,000 patients with bemiparin

42 VTE events avoided per 1,000 patients with bemiparin

Bemiparin dominant

Not reported

Bemiparin

*Attanasio, 2001, dermatan sulfate versus UFH 5,000 U, 3 times daily

Surgical cancer

Net saving ($53,000) per 1,000 patients with dermatan sulfate

70 DVTs avoided and 3.1 lives gained per 1,000 patients with dermatan sulfate

Dermatan sulfate dominant

Five additional major bleeding events with dermatan sulfate

Dermatan sulfate

Heerey, 2005, dalteparin 2,500 U versus dalteparin, 5,000 U

Abdominal surgery

$477,000 per 1,000 patients with dalteparin

18 QALYs per 1,000 patients with dalteparin

$24,357/QALY gained with dalteparin

Not reported

Dalteparin 5,000 U

Wade, 2001, tinzaparin versus enoxaparin

Spinal cord injury

$223,259 per 1,000 patients with enoxaparin

Not reported

Not reported

Not reported

Not reported

Fondaparinux versus enoxaparin

Reference

Patient population

Incremental cost (USD)

Incremental effects (VTE avoided or life-years or QALYS gained)

ICER (USD/VTE event avoided or life-years or QALYS gained)

Bleeding complications

Most economically attractive drug

*Gordois, 2003

THR, TKR, HFS

$10,000 per 1,000 patients by discharge from hospital with fondaparinux

11 VTE events, 1.9 deaths avoided per 1,000 patients by discharge from hospital with fondaparinux

$1, 077 per VTE event avoided and $5,317 per death avoided with fondaparinux

Not reported

Fondaparinux

*Lundkvist, 2003

THR, TKR, HFS

Net saving ($59,000) per 1,000 patients with fondaparinux

17.9 VTE events, 2.6 deaths avoided per 1,000 patients (average among three conditions) with fondaparinux

Fondaparinux dominant

Not reported

Fondaparinux

Wade, 2003, enoxaparin, 30 mg twice daily enoxaparin, 40 mg once daily

THR

Net savings ($168,382) per 1,000 patients with enoxaparin

Three VTE events per 1,000 patients with enoxaparin

Enoxaparin dominant

27 more bleeding episodes per 1,000 patients with fondaparinux compared with twice-daily enoxaparin Six more bleeding episodes per 1,000 patients with enoxaparin once daily compared with fondaparinux

Enoxaparin twice daily

Annemans, 2004

THR, TKR, HFS

$2,800 per 1,000 patients with fondaparinux

17.7 VTE events per 1,000 patients with fondaparinux

$158 per VTE event avoided; $104 per death avoided with fondaparinux

1.6 more bleeding episodes per 1,000 patients with fondaparinux

Fondaparinux

*Dranitsaris, 2004

THR, TKR, HFS

Net saving ($50,000) per 1,000 patients with fondaparinux

16 VTE avoided per 1,000 patients with fondaparinux

Fondaparinux dominant

10 more major bleeding events per 1,000 patients with fondaparinux

Fondaparinux

Spruill, 2004

TKR (2002 USD)

Net saving ($43,549) per 1,000 patients with fondaparinux

36 VTE events avoided per 1,000 patients with fondaparinux

Fondaparinux dominant

10 more major bleeds and three more minor bleeding events per 1,000 patients with fondaparinux

Fondaparinux

Spruill, 2004

THR (2002 USD)

Net saving ($18,898) per 1,000 patients with fondaparinux

20 VTE events avoided per 1,000 patients with fondaparinux

Fondaparinux Dominant

19 more major bleeding events per 1,000 patients with fondaparinux

Fondaparinux

Wade, 2004

HFS

$21,171 per 1,000 patients with fondaparinux

34 VTE events avoided per 1,000 patients with fondaparinux

$623 per VTE avoided, $32,144 per QALY gained with fondaparinux

Approximately 20% increased bleeding costs for fondaparinux

Fondaparinux

*Sullivan, 2004

THR, TKR, HFS

Net savings ($67,000) per 1,000 patients treated with fondaparinux

3.7 VTE events avoided per 1,000 patients with Fondaparinux

Fondaparinux dominant

Two more bleeding events per 1000 patients with Fondaparinux

Fondaparinux

*Szucs, 2005

THR, TKR, HFS

Net savings ($18,153) per 1,000 patients treated with fondaparinux

8.1 VTE events avoided per 1,000 patients with fondaparinux

Fondaparinux dominant

1.6 more bleeding events per 1,000 patients with fondaparinux

Fondaparinux

*Bjorvatn, 2005

THR, TKR, HFS

$53,553 per 1,000 patients treated with fondaparinux

7.2 VTE events avoided per 1,000 patients with fondaparinux

$753 per VTE avoided, $6,782 per death avoided with fondaparinux

Two more bleeding events per 1,000 patients treated with fondaparinux

Fondaparinux

Dabigatran versus rivaroxaban and low-molecular-weight heparins

Wolowacz, 2009

THR

THR Net savings ($103,050) per 1,000 patients treated with dabigatran

Two VTEs avoided, eight life-years, six QALYs gained per 1,000 patients treated with dabigatran

Dabigatran dominant

Five additional major bleeding events, two episodes HIT avoided per 1,000 patients treated with dabigatran

Dabigatran

 

TKR

Net savings ($8,162) per 1,000 patients treated with dabigatran

Four VTEs avoided, 9 life-years, 7 QALYs gained per 1,000 patients treated with dabigatran

Dabigatran dominant

Six additional major bleeding events, two episodes HIT avoided per 1,000 patients treated with dabigatran

 

McCullagh, 2009

THR

Net savings ($24,104) per 1,000 patients treated with rivaroxaban

7 Life-years, 10 QALYs gained per 1,000 patients with rivaroxaban

Rivaroxaban dominant

Not reported

Rivaroxaban

 

TKR

Net savings ($213,452) per 1,000 patients treated with rivaroxaban

7 Life-years, 12 QALYs gained per 1,000 patients with rivaroxaban

Rivaroxaban dominant

  
  1. HFS, hip-fracture surgery; ICER, incremental cost-efficacy ratio; LMWH, low-molecular-weight heparin; THR, total hip replacement; UFH, unfractionated heparin; USD, United States dollars; VTE, venous thromboembolism. *Industry-sponsored study.