Skip to main content
SpringerLink
Log in

Cost Effectiveness of Desirudin Compared with a Low Molecular Weight Heparin in the Prevention of Deep Vein Thrombosis after Total Hip Replacement Surgery

  • Original Research Article
  • Published:
PharmacoEconomics Aims and scope Submit manuscript

Abstract

Objectives: This prospective pharmacoeconomic study analyses and discusses the cost effectiveness (expressed as cost per life-year gained) of desirudin 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 included together with epidemiological data in a decision tree, simulating long term cost effectiveness of patients undergoing elective hip replacement. The 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 prophylactic therapy with enoxaparin is 7022 Swedish kronor (SEK) compared with SEK7497 when using desirudin (1998 values). The total costs with desirudin are 7% higher. Prophylaxis with desirudin in those patients undergoing elective hip replacement surgery adds, on average, 7 days of life per patientwhen compared with treatment using enoxaparin. This is equivalent to 1.91 additional years of life per 100 patients treated. The incremental cost-effectiveness ratio of prophylaxis with desirudin in patients undergoing elective hip replacement surgery is SEK24 864 per life-year gained in comparison with enoxaparin.

Conclusion: The present study demonstrates that prophylactic therapy with desirudin is a cost-effective approach for the prevention of DVT in patients undergoing total hip replacement.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Table I
Fig. 1
Fig. 2
Fig. 3
Table II
Table III
Table IV
Table V
Table VI

Similar content being viewed by others

References

  1. Nicolaides AN. Consensus statement. Prevention of venous thromboembolism. Int Angiol 1997; 16: 3–38

    Google Scholar 

  2. Second Thromboembolic Risk Factors (THRiFT II) Consensus Group. Risk of and prophylaxis for venous thromboembolism in hospital patients. Phlebologie 1998; 13: 87–97

    Google Scholar 

  3. Clagett GP, Anderson Jr FA, Geerts W, et al. Prevention of venous thromboembolism. Chest 1998; 114 Suppl. 5: 531S–60S

    Article  PubMed  CAS  Google Scholar 

  4. Nurmohamed MT, Rosendaal FR, Büller HR, et al. Low molecular weight heparin versus standard heparin in general and orthopaedic surgery: an meta-analysis. Lancet 1992; 340: 152–6

    Article  PubMed  CAS  Google Scholar 

  5. Imperiale TF, Speroff T. A meta-analysis of methods to prevent venous thromboembolism following total hip replacement. JAMA 1994; 271: 1780–5

    Article  PubMed  CAS  Google Scholar 

  6. Eriksson BI, Ekman S, Kälebo P, et al. Prevention of deep-vein thrombosis after total hip replacement: direct thrombin inhibition with recombinant hirudin, CGP 39393. Lancet 1996; 347: 635–9

    Article  PubMed  CAS  Google Scholar 

  7. Eriksson BI, Ekman S, Lindbratt S, et al. Prevention of thromboembolism with use of recombinant hirudin. Results of a double-blind, multicenter trial comparing the efficacy of desirudin (Revasc®) with that of unfractionated heparin in patients having a total hip replacement. J Bone Joint Surg Am 1997; 79: 326–33

    PubMed  CAS  Google Scholar 

  8. Eriksson BI, Wille-Jørgensen P, Kälebo P, et al. A comparison of recombinant hirudin with a low molecular weight heparin to prevent thromboembolic complications after total hip replacement. N Engl J Med 1997; 337: 1329–35

    Article  PubMed  CAS  Google Scholar 

  9. Levin L-Å, Horst M, Bergqvist D. Economic evaluation of desirudin vs heparin in deep vein thrombosis prevention after hip replacement surgery. Pharmacoeconomics 1998; 13: 111–18

    Article  PubMed  CAS  Google Scholar 

  10. Oster G, Tuden RL, Colditz GA. Prevention of venous thromboembolism after general surgery. Cost-effectiveness analysis of alternative approaches to prophylaxis. Am J Med 1987; 82: 889–99

    Article  PubMed  CAS  Google Scholar 

  11. Oster G, Tuden RL, Colditz GA. A cost-effectiveness analysis of prophylaxis against deep-vein thrombosis in major orthopedic surgery. JAMA 1987; 257: 203–8

    Article  PubMed  CAS  Google Scholar 

  12. Hillson SD, Rich EC. Two strategies for prophylaxis of fatal postoperative pulmonary embolism. Cost-effectiveness analysis. Int J Tech Assessment H Care 1990; 6: 470–9

    Article  CAS  Google Scholar 

  13. Bergqvist D, Jendteg S, Lindgren B, Mätzsch T, et al. The economics of general thromboembolic prophylaxis. World J Surg 1988; 12: 349–55

    Article  PubMed  CAS  Google Scholar 

  14. Paiement GD, Wessinger SJ, Harris WH. Cost-effectiveness of prophylaxis in total hip replacement. Am J Surg 1991; 161: 519–24

    Article  PubMed  CAS  Google Scholar 

  15. Bergqvist D. Cost-effectiveness of venous thromboembolism prophylaxis in surgery. Eur J Surg 1994; 571 Suppl: 49–53

    Google Scholar 

  16. O’Brien BJ, Anderson DR, Goeree R. Cost-effectiveness of enoxaparin versus warfarin prophylaxis against deep-vein thrombosis after hip replacement. Can Med Ass J 1994; 150: 1083–90

    Google Scholar 

  17. Beyth RJ, Cohen AM, Landefeld CS. Long-term outcomes of deep-vein thrombosis. Arch Intern Med 1995; 155: 1031–7

    Article  PubMed  CAS  Google Scholar 

  18. Bergqvist D, Jendteg S, Johansen L, et al. Cost of long-term complications of deep venous thrombosis of the lower extremities: an analysis of a defined patient population in Sweden. Ann Intern Med 1997; 126: 454–7

    PubMed  CAS  Google Scholar 

  19. Statistiska centralbyrån (SCB). Statistical abstract of Sweden 1992. Stockholm Statistics. Stockholm, Sweden, 1992

    Google Scholar 

  20. Farmacevtiska specialiteter i Sverige. FASS 1995. Stockholm: LINFO, 1995

    Google Scholar 

  21. Tengs TO, Adams ME, Pliskin JS, et al. Five-hundred life-saving interventions and their cost-effectiveness. Risk Anal 1995; 15: 369–90

    Article  PubMed  CAS  Google Scholar 

  22. Jönsson B, Johannesson M, Kjekshus J, et al. Cost-effectiveness of cholesterol lowering. Results from the Scandinavian Simvastatin Survival Study (4S). Eur Heart J 1996; 17: 1001–7

    Article  PubMed  Google Scholar 

  23. Hull RD, Pineo GF, Francis C, et al. Low-molecular-weight heparin prophylaxis using dalteparin extended out-of-hospital vs in-hospital warfarin/out-of-hospital placebo in hip arthroplasty patients: a double-blind, randomized comparison. Arch Intern Med 2000; 160 (14): 2208–15

    Article  PubMed  CAS  Google Scholar 

  24. Swedish Board of Health and Welfare. Stockholm, 1996 (Data on file)

Download references

Author information

Authors and Affiliations

  1. Centre for Medical Technology Assessment, Linköping University, SE-581 83, Linköping, Sweden

    Lars-Åke Levin

  2. Department of Surgery, Uppsala University, Uppsala, Sweden

    David Bergqvist

Authors
  1. Lars-Åke Levin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. David Bergqvist
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Lars-Åke Levin.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Levin, LÅ., Bergqvist, D. Cost Effectiveness of Desirudin Compared with a Low Molecular Weight Heparin in the Prevention of Deep Vein Thrombosis after Total Hip Replacement Surgery. Pharmacoeconomics 19, 589–597 (2001). https://doi.org/10.2165/00019053-200119050-00012

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00019053-200119050-00012

Keywords

Search

Navigation