Cost–effectiveness of extended venous thromboembolism prophylaxis with fondaparinux in hip surgery patients

In the Penthifra Plus trial, extended prophylaxis with the synthetic pentasaccharide fondaparinux for 1 month versus 1 week in hip fracture surgery has been shown to reduce the risk of venous thromboembolic events by 96%. The cost-effectiveness of extended prophylaxis with fondaparinux still remains to be determined. The authors developed a decision analytic cost-effectiveness model comparing the use of fondaparinux for 4 weeks with 1 week from a healthcare perspective. The analyses were performed for patients undergoing hip fracture surgery and total hip replacement (THR). Efficacy data were extracted from published randomized controlled trials and natural history data after venous thromboembolic events from observational studies. Cost data were derived from the literature and other published sources. Costs were expressed in 2004 Swiss Francs (CHF) and effects as life-years gained (LYG). In patients undergoing hip fracture surgery, the incremental cost-effectiveness ratio of extended 4-week fondaparinux prophylaxis versus a 1-week regimen was CHF 2801/LYG after 30 days, with cost-savings after 5 years. In patients undergoing THR, the respective incremental cost-effectiveness ratio of extended fondaparninux prophylaxis was CHF 20,294/LYG after 30 days, with cost-savings after 5 years. In the authors' model, the substantial clinical benefit of extended thromboembolism prophylaxis with fondaparinux in major orthopedic surgery translates into favorable cost-effectiveness figures in the short term and cost savings when a 5-year time horizon is used.