A cost-utility analysis of dabigatran, enoxaparin, and usual care for venous thromboprophylaxis after hip or knee replacement surgery in Thailand

Kotirum, Surachai, Chongmelaxme, Bunchai and Chaiyakunapruk, Nathorn (2016) A cost-utility analysis of dabigatran, enoxaparin, and usual care for venous thromboprophylaxis after hip or knee replacement surgery in Thailand. Journal of Thrombosis and Thrombolysis, 43 2: 1-11. doi:10.1007/s11239-016-1433-5


Author Kotirum, Surachai
Chongmelaxme, Bunchai
Chaiyakunapruk, Nathorn
Title A cost-utility analysis of dabigatran, enoxaparin, and usual care for venous thromboprophylaxis after hip or knee replacement surgery in Thailand
Journal name Journal of Thrombosis and Thrombolysis   Check publisher's open access policy
ISSN 1573-742X
0929-5305
Publication date 2016-10-04
Sub-type Article (original research)
DOI 10.1007/s11239-016-1433-5
Open Access Status Not yet assessed
Volume 43
Issue 2
Start page 1
End page 11
Total pages 11
Place of publication New York, NY, United States
Publisher Springer New York LLC
Language eng
Subject 2720 Hematology
2705 Cardiology and Cardiovascular Medicine
Abstract To analyze the cost-utility of oral dabigatran etexilate, enoxaparin sodium injection, and no intervention for venous thromboembolism (VTE) prophylaxis after total hip or knee replacement (THR/TKR) surgery among Thai patients. A cost-utility analysis using a decision tree model was conducted using societal and healthcare payers’ perspectives to simulate relevant costs and health outcomes covering a 3-month time horizon. Costs were adjusted to year 2014. The willingness-to-pay threshold of THB 160,000 (USD 4926) was used. One-way sensitivity and probabilistic sensitivity analyses using a Monte Carlo simulation were performed. Compared with no VTE prophylaxis, dabigatran and enoxaparin after THR and TKR surgery incurred higher costs and increased quality adjusted life years (QALYs). However, their incremental cost-effectiveness ratios were high above the willingness to pay. Compared with enoxaparin, dabigatran for THR/TKR lowered VTE complications but increased bleeding cases; dabigatran was cost-saving by reducing the costs [by THB 3809.96 (USD 117.30) for THR] and producing more QALYs gained (by 0.00013 for THR). Dabigatran (vs. enoxaparin) had a 98 % likelihood of being cost effective. Dabigatran is cost-saving compared to enoxaparin for VTE prophylaxis after THR or TKR under the Thai context. However, both medications are not cost-effective compared to no thromboprophylaxis.
Keyword Cost-utility analysis
Dabigatran
Enoxaparin
Prophylaxis
Thailand
Venous thromboembolism
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
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