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2012, Number 5

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Cir Cir 2012; 80 (5)

Economic analysis of dalteparin use in knee surgery at Instituto Mexicano del Seguro Social

Arreola-Ornelas H, Rosado-Buzzo A, García-Mollinedo L, Dorantes-Aguilar J, Muciño-Ortega E, Mould-Quevedo JF

Language: Spanish
References: 40
Page: 411-418
PDF size: 150.66 Kb.


ABSTRACT

Background: knee surgery is a risk factor for thromboembolic disease. Prophylaxis reduces the risk of this condition.
Methods: economic and health consequences of drugs preventing and treating thromboembolic disease in patients undergoing knee surgery from the institutional perspective (time horizon: one year) were estimated. The measures of effectiveness were: reduction in the number of cases (per 1,000 patients) of deep vein thrombosis, pulmonary embolism, hospital admissions and deaths. Transition probabilities were estimated by meta-analysis. The alternatives were: warfarin (reference), dalteparin, enoxaparin, nadroparin, unfractionated heparin + warfarin, and non-prophylaxis. Data on resources use and costs corresponds to the Instituto Mexicano del Seguro Social (IMSS). Acceptability curves were constructed.
Results: no prophylaxis implied three times higher cost ($18,835.1 versus $5,967.1) and less effectiveness in comparison with warfarin. The incremental cost-effectiveness ratios for enoxaparin were $3, $13, $17 y $3 per each additional case of deep vein thrombosis, pulmonary embolism, death and hospital admission avoided. Results of nadroparin and unfractionated heparin were inferior to warfarin (59.1% and 72.9% more costly and less effective in three measures of effectiveness, respectively). Dalteparin showed higher health outcomes and lower cost compared with warfarin (-20.6%). Dalteparin had a higher probability of being cost-effective than enoxaparin.
Discussion: thromboprophylaxis is a clinically and economically favorable alternative. The identification of a pharmacoeconomic profile of alternatives to perform it becomes relevant given the increasing pressure on institutional budgets.
Conclusions: dalteparin would be a cost-saving alternative in thromboprophylaxis of patients undergoing knee surgery at IMSS.


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