Comparison of the two-year outcomes and costs of prophylaxis in medical patients at risk of venous thromboembolism Article

Full Text via DOI: 10.1160/TH08-04-0248 PMID: 18989525 Web of Science: 000260958200019
Industry Collaboration

Cited authors

  • Deitelzweig, Steven B.; Becker, Russ; Lin, Jay; Benner, Josh


  • A decision-analytic model incorporating a Markov process to assess the incremental cost and effectiveness of venous thromboembolism (VTE) prevention strategies was used. Modeling was carried out using a hypothetical cohort of medical patients at risk of VTE. The model compared clinical effectiveness (primary and recurrentVTE, death), safety (adverse events), and direct medical costs between patients receiving enoxaparin prophylaxis, unfractionated heparin (UFH) prophylaxis, and no prophylaxis (n = 10,000 for each arm). Monte Carlo simulation was performed to identify changes in inputs that would affect the results. The estimated incidence of VTE at two years (including recurrentVTE) was 6.8% with enoxaparin prophylaxis, 7.9% with UFH prophylaxis, and 17.9% with no prophylaxis. Two-year mortality occurred in 15.7% of enoxaparin patients and 16.0% of UFH patients, with the incidences of major bleeding in these groups being 0.7% and 1.2%, respectively. However, both enoxaparin and UFH prophylaxis were associated with higher rates of major bleeds than no prophylaxis (0.6%). Total average costs per patient were (US dollars) $1,264 (for enoxaparin prophylaxis, $1,585 for UFH prophylaxis, and $2,245 for no prophylaxis). No realistic parameter changes resulted in enoxaparin prophylaxis being more costly than UFH prophylaxis. For the healthcare payer, considering all direct medical costs associated withVTE up to two years after an admission for acute illness, prophylaxis with enoxaparin was more effective and less costly than UFH. This identifies enoxaparin as a potentially favorableVTE prophylaxis regimen compared with UFH and no prophylaxis in at-risk medical patients.

Publication date

  • 2008

Published in

International Standard Serial Number (ISSN)

  • 0340-6245

Start page

  • 810

End page

  • 820


  • 100


  • 5