Extended Prophylaxis with Fondaparinux versus Enoxaparin against Venous Thromboembolism

Patients undergoing major orthopaedic surgery face considerable risk of venous thromboembolic complications (VTE). This paper presents cost-effectiveness analysis of extended prophylaxis with fondaparinux and enoxaparin in patients undergoing hip fracture surgery (HFS) and total hip replacement (THR). The analysis is based on Norwegian data, which include about 50,000 patients who underwent HFS and THR in the period from 1999 to 2001. All cost estimates in the model are based on the Norwegian unit costs.
The results from clinical outcomes show that in general, fondaparinux is the more effective drug in terms of preventing VTE-events in all time periods. Fondaparinux is also more cost-effective compared to enoxaparin with respect to costs per death avoided and costs per life year gained. The sensitivity analysis confirmed the robustness of the main results. The results were however sensitive to price reductions of fondaparinux.