A Cost Analysis of Fondaparinux Versus Enoxaparin in Total Knee Arthroplasty

Several hundred thousand total knee replacement (TKR) surgeries are performed in the United States each year. The American College of Chest Physicians has classified TKR patients in the "highest-risk" category for developing venous thromboembolic events. Recommended prophylactic agents following TKR surgery include unfractionated heparin and low-molecular weight heparins. Fondaparinux is a selective inhibitor of factor Xa and has recently received approval for the prophylaxis of venous thromboembolism in TKR patients. In November 2001, an efficacy study comparing fondaparinux with enoxaparin as deep vein thrombosis prophylaxis in TKR surgery was published by Bauer et al. The purpose of the current study was to perform an incremental cost analysis for fondaparinux versus enoxaparin using the efficacy and safety data of the Bauer et al study. Specific comparisons evaluated included cost per venous thromboembolic event avoided, cost per death averted, and cost per life-year gained with fondaparinux and enoxaparin. All analyses were performed from an institutional perspective and projected to 1000 patients. The incremental cost analysis indicates an USD $1081.33 cost savings with fondaparinux over enoxaparin per venous thromboembolic event avoided. Cost per death averted in the enoxaparin group is USD $88,943.54; cost per death averted in the fondaparinux groups is USD $81,157.94. Cost per life-year gained of USD $5437 for enoxaparin and USD $4925 for fondaparinux.