ArticleJournal of orthopaedic surgery and research2019
A comparative cost-effectiveness analysis of mechanical and pharmacological VTE prophylaxis after lower limb arthroplasty in Australia.
Article in Journal of orthopaedic surgery and research, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 1 of them a synthesis that pooled it.
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Who cites it
8 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Combined intermittent pneumatic leg compression and pharmacological prophylaxis for prevention of venous thromboembolism.The Cochrane database of systematic reviews · 2022Pooled it
- Barriers and facilitators to the implementation of guidelines for venous thromboembolism prevention and management: A mixed-methods systematic review.International journal of nursing studies advances · 2025Review
- Compliance with Australian Orthopaedic Association guidelines does not reduce the risk of venous thromboembolism after total hip and knee arthroplasty.Scientific reports · 2024Article
- Robotic-assisted total knee arthroplasty is not associated with increased risk of postoperative deep vein thrombosis.Journal of experimental orthopaedics · 2023Article
- Cost-effectiveness of mechanical thromboprophylaxis for cesarean deliveries in Brazil.PloS one · 2023Article
- Role of Direct Oral Anticoagulants for Post-operative Venous Thromboembolism Prophylaxis.European cardiology · 2022Review
- Non-compliance with clinical guidelines increases the risk of complications after primary total hip and knee joint replacement surgery.PloS one · 2021Article
- EFFECTIVENESS OF DEEP VENOUS THROMBOSIS PREVENTION IN TOTAL HIP ARTHROPLASTY.Acta ortopedica brasileiraArticle
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Authors and funding
3 authors.
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No grant is acknowledged in the PubMed record.
Abstract
backgroundVenous thromboembolism (VTE) is a complication following surgery. Low-molecular-weight heparin (LMWH) or direct oral anticoagulants (DOACs) are efficacious but come with inherent bleeding risk. Mechanical prophylaxis, such as intermittent pneumatic compression (IPC), does not induce bleeding but may be difficult to implement beyond the immediate post-operative period. This study compared the cost and quality-adjusted life years (QALYs) saved of commonly used VTE prophylaxis regimens after lower limb arthroplasty.
methodsA previously published cost-utility model considering major efficacy and safety endpoints was updated to estimate the 1-year cost-effectiveness of different VTE prophylaxis regimens. The VTE strategies assessed included apixaban, dabigatran, rivaroxaban, LMWH, IPC, IPC + LMWH and IPC + apixaban. Efficacy data were derived from studies in PubMed, and cost data came from the 2017 Australian AR-DRG and PBS pricing schemes.
resultsCosts for VTE prophylaxis including treatment of its associated complications over the first year after surgery ranged from AUD $644 (IPC) to AUD $956 (rivaroxaban). Across 500 simulations, IPC was the cheapest measure in 73% of simulations. In 97% of simulations, a DOAC was associated with the highest resulting QALYs. Compared to IPC, apixaban was cost-effective in 76.4% of simulations and apixaban + IPC in 87.8% of simulations. For VTE events avoided, the DOACs and IPC were on par. LMWH and LMWH + IPC were negatively dominated.
conclusionsApixaban, IPC or a sequential/simultaneous combination of both is currently the most cost-effective VTE prophylaxis regimens. The choice between them is best guided by the relative VTE and bleeding risks of individual patients.
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