Cost-Effectiveness of Fondaparinux vs Enoxaparin as Venous Thromboembolism Prophylaxis in Norway

Patients undergoing major orthopaedic surgery face considerable risk of venous thromboembolic complications (VTE), which may be fatal, unless they receive prophylactic treatment. Fondaparinux (Arixtra®) is a new antithrombotic agent, which is indicated for prophylaxis of VTE. The report presents a cost-effectiveness analysis of Fondaparinux versus Enoxaparin, which is the most common prophylaxis of VTE. The analysis is based on Norwegian data, which include over 55.000 patients who underwent orthopaedic surgery in the period from 1999 to 2001. The model estimates expected incidence of VTE and expected costs estimates of VTE-related care for each of the two prophylaxes for different time periods. The results indicate that Fondaprinux is likely to be more effective than Enoxaparin in preventing the incidence of VTE. For long follow-up periods, more precisely, 5 years, Fondaparinux is also likely to represent the lower cost treatment. For hip fracture surgery, Fondaparinux is cost-saving also in the short follow-up time. In addition, the results indicate that Fondaparinux avoids between 3 and 34 VTE-related deaths per 10.000 patients compared to Enoxaparin. Our cost-benefit analysis indicates that Fondaparinux may be the more economical choice. The sensitivity analyses show that our results are robust to changes in the most important parameters. Also in the extreme cases where the Enoxaparin price is reduced by 60% to 100%, Arixtra is still cost-effective alternative after hip fracture surgery in the 5-year follow-up time compared to Enoxaparin.