Cost-effectiveness of desirudin in the prevention of the thromboembolic complications of surgery

SummaryNew therapies reduce the risk of deep-vein thrombosis (DVT) following orthopaedic surgery, but may be more costly than low-molecular-weight heparin, the current standard treatment. Decision analysis and life-table methods were used to model the incremental cost-effectiveness of Revasc® (desirudin) compared with low-molecular-weight heparin (enoxaparin) in DVT prophylaxis following total hip replacement. A health-service perspective (payer, prescriber) was adopted and the principal endpoint was cost/life-year saved over 15 years. Costs were updated from published Swedish data to reflect 1998/9 UK prices and practices.Prophylactic treatment with desirudin rather than enoxaparin for the prevention of thromboembolic complications of hip surgery should lead to an increase of 4.69 life-years/100 patients over 15 years, at an increased cost of £12,026/100 patients: the cost per life-year saved is therefore £2,566. This compares favourably with a range of commonly used alternative interventions. Desirudin is therefore a cost-effective method of preventing postoperative DVT in patients undergoing total hip replacement surgery.