Cost-effectiveness of Dalteparin Versus Unfractionated Heparin as Venous Thromboembolism Prophylaxis in Malignant Gynecologic Surgery

Venous thromboembolic events (VTEs) are serious complications that may occur in the patient undergoing surgery for gynecologic malignancies. The American College of Chest Physicians recommends unfractionated heparin or low-molecular weight heparin as prophylaxis for deep vein thrombosis and pulmonary embolism in this patient population. Cost-effectiveness analyses comparing unfractionated heparin 3 times a day versus once daily dalteparin using published efficacy and safety data demonstrate cost savings if dalteparin were routinely utilized as VTE prophylaxis. Sensitivity analyses support this finding at the upper end of the range of reported proximal DVT, nonfatal pulmonary embolism, and major bleeding incidences. These findings should be viewed as preliminary, and institutions are encouraged to perform their own cost-effectiveness studies in this patient population.