Management patterns of thrombosis prophylaxis and related costs in hip and knee replacement in Germany

The objective of the study was to depict treatment strategies, health care utilisation and cost evaluation of hip and knee replacement surgery in Germany, with a particular emphasis on thrombosis prophylaxis (TP) for the prevention of deep vein thrombosis (DVT). In this multi-centre prospective cohort study, medical record data (socio-demographics, risk factors for thrombosis, thrombosis prophylaxis, course of hospital stay) were collected for patients undergoing either total hip replacement (THR) or total knee replacement (TKR). One and three months post-operatively, post-operative outcomes and health care resource use were documented by patient and physician questionnaires. A total of 309 patients participated in the study (59% female, mean age 66 [SD 10] years). Parenteral anticoagulation was administered for a mean of 38 (SD 16) days. 27 (9%) patients received subsequent oral anticoagulation for a mean of 38 (SD 21) additional days. Symptomatic DVT was reported by four (1.3%) patients. Mean overall direct costs associated with surgery from baseline to 3 months were EUR 11 264 (median 11 564, SD 2 481). Hospital and rehabilitation accounted for 97% of direct costs; costs for medications, physical therapy, physician office visits, out-of-pocket expenses, as well as complication costs accounted for an additional 3% of direct costs. Within these direct costs, a mean of EUR 348 (SD 361) was related to thrombosis prophylaxis, accounting for 3% of direct costs. Mean overall cost was EUR 11 926 (SD 2 481), including 6% indirect costs of productivity loss. Extended thrombosis prophylaxis was observed in the usual care setting of the study and associated with low incidence of symptomatic DVT. Thrombosis prophylaxis is — within the considerable economic burden of joint replacement surgery — a relatively small cost component.