Cost-effectiveness of venous thromboembolism prophylaxis protocol implementation compared to routine clinical practice in a tertiary hospital in Thailand

Introduction: Venous thromboembolism (VTE) is a significant global health concern associated with substantial morbidity and mortality. Despite established guidelines for VTE prevention, there exists a gap between clinical recommendations and their implementation in practice. This study focuses on the implementation of a VTE prophylaxis protocol at a public hospital in Thailand, aiming to evaluate its cost-effectiveness. Methods: A decision tree model was used to conduct a cost-effectiveness analysis, comparing the costs and health-related outcomes pre- and post-implementation of a risk-based VTE prophylaxis protocol, including pharmacological and mechanical prophylaxis, and early ambulation. The analysis was conducted from the perspective of a single public hospital and followed a 1-year time horizon. Results: The base case analysis showed that the implementation of the VTE prophylaxis protocol resulted in an incremental cost of THB 726.46 per patient over a 1-year horizon, with an additional 0.30 QALYs. The resulting incremental cost-effectiveness ratio (ICER) was THB 2453.21 per QALY, well below the local willingness-to-pay threshold. Sensitivity analyses confirmed the robustness of the findings, and even in extreme value scenarios, the protocol remained cost-effective. Conclusions: This study demonstrates the cost-effectiveness of implementing a comprehensive VTE prophylaxis protocol in a Thai hospital setting. While the study focused on a single center, the results suggest that similar protocol implementation may be effective in other tertiary hospitals with comparable resource utilization and unit costs. This research provides valuable evidence to inform healthcare resource allocation and decision-making in Thailand and potentially in other regions facing similar challenges in VTE prevention.