Thromboprophylaxis and total hip replacement: A cost-efficacy study comparing duplex screening of asymptomatic venous thrombosis versus prolonged prophylaxis with low-molecular-weight heparins

2002 ◽  
Vol 17 (3-4) ◽  
pp. 93-97
Author(s):  
M. T. Barrellier
Keyword(s):  
Molecular Weight ◽  
Venous Thrombosis ◽  
Total Hip Replacement ◽  
Hip Replacement ◽  
Low Molecular Weight ◽  
Efficacy Study ◽  
Low Molecular Weight Heparins ◽  
Total Hip ◽  
Cost Efficacy

Thromboprophylaxis and Total Hip Replacement: A Cost-Efficacy Study Comparing Duplex Screening of Asymptomatic Venous Thrombosis versus Prolonged Prophylaxis with Low-Molecular-Weight Heparins

2002 ◽  
Vol 17 (3-4) ◽  
pp. 93-97
Author(s):  
M. T. Barrellier
Keyword(s):  
Molecular Weight ◽  
Direct Cost ◽  
Hip Replacement ◽  
Prophylactic Treatment ◽  
Low Molecular Weight ◽  
Low Molecular Weight Heparins ◽  
Total Hip ◽  
Total Hip Replacements ◽  
Annual Budget ◽  
Hip Replacements

Background: Despite use of the anti-thrombotic prophylaxis, clinical thrombo-embolic events and fatal pulmonary embolism are still observed after total hip replacement. To reduce these complications, two strategies have been adopted: to prolong the use of low-molecular-weight heparins (LMWH) to 35 days or to screen patients systematically before discharge, using duplex ultrasonography, following the short-course prophylactic treatment. Objective: To assess, based on published literature, the relative costs and benefits of these two strategies for prophylaxis following total hip arthroplasty. Method: The author identified relevant papers in this field from his own resources and from medical literature databases. Synthesis: Prolonging LMWH treatment to a total of 35 days represents a direct cost in France of approximately £340 per patient, or for 100000 total hip replacements per year, an annual budget of £34 000000. If this strategy attained maximum efficacy, it would avoid 150 fatal pulmonary embolisms. The direct cost would therefore be at least £227000 per life saved. A systematic single duplex ultrasound examination before discharge from hospital would cost £76 per patient, or for 100 000 arthroplasties a total annual budget in France of £7 600000. If this approach achieved maximum efficacy, preventing the 150 fatal pulmonary embolisms corresponding to 100000 total hip replacements, the minimum direct cost would be £50 300 per life saved. Conclusion: Duplex screening may be more effective and lest costly than prolongation of prophylactic treatment using LMWH. This deduction needs to be confirmed by complex cost-benefit studies using clinical end-points.

Sign in / Sign up

Export Citation Format

Share Document