A 7-day course of enoxaparin 40 mg daily was cost-effective for VTE prophylaxis only in posterior lumbar fusions of 7-12 segments (NNT=50), but not for fewer than 7 segments.
Does a 7-day course of enoxaparin 40 mg daily improve cost-effectiveness for VTE prophylaxis in patients undergoing posterior lumbar fusion?
A 7-day course of enoxaparin is cost-effective for VTE prophylaxis in posterior lumbar fusions of 7-12 segments, but not for fewer segments under current cost assumptions.
Number Needed to Treat: 50
Número necesario a tratar: 50
STUDY DESIGN: Break-even cost analysis. OBJECTIVES: This study uses a break-even cost-effectiveness model to assess whether enoxaparin is cost-effective for venous thromboembolism (VTE) prophylaxis in patients undergoing posterior lumbar fusion (PLF). METHODS: A 7-day course of enoxaparin 40 mg daily was evaluated using average retail drug costs and literature-based treatment costs for symptomatic VTE. VTE rates after PLF at 2, 3-6, and 7-12 vertebral segments were identified in the TriNetX Diamond database (2018-2023) for patients without prophylaxis. A break-even model calculated the absolute risk reduction and number needed to treat (NNT) for cost-effectiveness. RESULTS: The 7-day enoxaparin course cost 411. 34, and treating a symptomatic VTE cost 20, 461. 32. The overall VTE rate was 0. 49%; rates were 0. 38% (2-segment), 0. 65% (3-6 segments), and 2. 7% (7-12 segments). Enoxaparin was cost-effective only for 7-12 segment fusions (NNT=50). Sensitivity analyses demonstrated cost-effectiveness for all PLF and 3-6 segment fusions if drug cost is ≤100. 00, or for 2-segment fusions if ≤50. 00. Alternatively, it is cost-effective if VTE treatment costs ≥100, 000 (all PLF, 2-segment) or ≥75, 000 (3-6 segments). CONCLUSIONS: Enoxaparin is cost-effective for PLF of 7-12 segments but not for PLF of fewer than 7 segments. Lower drug costs or higher treatment costs could make prophylaxis cost-effective for PLF of fewer segments.
Chopra et al. (Mon,) conducted a other in Posterior lumbar fusion (PLF). Enoxaparin vs. No prophylaxis was evaluated on Cost-effectiveness for venous thromboembolism (VTE) prophylaxis (NNT 50). A 7-day course of enoxaparin 40 mg daily was cost-effective for VTE prophylaxis only in posterior lumbar fusions of 7-12 segments (NNT=50), but not for fewer than 7 segments.