Economic evaluation of enoxaparin for the prevention of venous thromboembolism in acutely ill medical patients

Abstract

Method: We used a previously described economic model created in the context of the UK National Health Service and applied it to St. Thomas’ Hospital, London. A clinical review to determine the number of medical admissions that would require thromboprophylaxis at St. Thomas’ Hospital, based on the inclusion criteria of a medical thromboprophylaxis trial (MEDENOX), was conducted. Costs and effectiveness were determined, based on the provision of thromboprophylaxis to 2000 medical patients.

Results: Comparing treatment with low-molecular-weight heparin (enoxaparin, 40 mg once daily), unfractionated heparin (5000 IU twice daily), or no prophylaxis, the highest cost of thromboprophylaxis was associated with unfractionated heparin (£199,000=€306,000), compared with enoxaparin (£198,000=€305,000) or no prophylaxis (£176,000=€271,000). The model suggested that enoxaparin thromboprophylaxis would result in fewer thromboembolic-related events. Using sensitivity analysis, incorporating certain St. Thomas’-specific costs showed enoxaparin compared with unfractionated heparin or no thromboprophylaxis was cost saving. The cost savings of £65,000 (=€100,000) and £31,000 (=€48,000) respectively are based on maximum uptake of thromboprophylaxis.

Conclusions: The graded implementation of enoxaparin thromboprophylaxis over a four-year period would require funding redistribution. The funding Health Authority would save overall but St. Thomas’ would require an increase in drug expenditure across the clinical directorates of £35,000 (= €54,000) after 4 years.