Economic evaluation of enoxaparin as prophylaxis against venous thromboembolism in seriously ill medical patients: a US perspective

Gregory de Lissovoy, Prasun Subedi
American Journal of Managed Care 2002, 8 (12): 1082-8

OBJECTIVE: To determine the cost and cost effectiveness of adding venous thromboembolism (VTE) prophylaxis with enoxaparin, a low-molecular-weight heparin, to standard care for acutely ill, hospitalized medical patients.

METHODS: A pharmacoeconomic model was developed to simulate the 6- to 14-day course of enoxaparin prophylaxis evaluated in the MEDENOX trial in a US healthcare setting. Clinical results as reported for the trial were applied to resource use and treatment costs in a US healthcare environment. The model projects hospital length of stay and cost for an acute medical admission from a third-party payer perspective, as well as costs for the course of enoxaparin.

RESULTS: VTE prophylaxis with enoxaparin would account for 1.2% to 2.4% of the cost of a hospital admission, with an additional $23 +/- $28 to $99 +/- $122 to complete the course of prophylaxis out of hospital. Incremental cost effectiveness of VTE prophylaxis relative to no prophylaxis ranges from $1249 to $3088 per VTE avoided. Venous thromboembolism prophylaxis appears to be a break-even intervention, with the cost recouped through avoided treatment, if the rate of treated VTE without prophylaxis is at least 3-4%.

DISCUSSION AND CONCLUSIONS: The MEDENOX trial demonstrated that prophylaxis with enoxaparin substantially decreases the risk of VTE among acutely ill, hospitalized medical patients. Economic analysis indicates that this protection represents a small increase in current treatment costs. Prophylaxis is cost effective in terms of incremental cost per VTE avoided. Furthermore, there is a reasonable likelihood that the cost of prophylaxis will be offset by avoided future VTE treatment.

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