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

Objectives: This paper presents an economic evaluation of a strategy of thromboprophylaxis in acutely ill medical patients with enoxaparin 40 mg vs. no intervention in the context of the French Health System.

Methods: The evaluation used a decision-analysis model to simulate the results of a hypothetical naturalistic, long-term study reflecting the usual care pattern for the patients. The short-term outcomes were derived from an international, double-blind, placebo-controlled randomized clinical study performed in 1102 patients older than 40 years. Treatment was scheduled to last 10 +/- 4 days and primary outcome was venous thromboembolism events rates between days 1 and 14 assessed clinically or through systematic contrast venography.

Results: For an hypothetical cohort of 1000 hospitalized medical patients, the model suggested that the prophylaxis strategy would avoid between 1 and 10 deaths (median 4) and between 60 and 127 cases of venous thromboembolism events (median 94). By including or not the costs associated with long-term complications (post-phlebitis syndrome), the net extra cost per patient was estimated as a net saving or 35,857 Euros (Euro), respectively. The corresponding cost-effectiveness ratios in terms of cost per avoided death were a net saving or Euro 8102 (median value), respectively.

Conclusions: Thromboprophylaxis with enoxaparin in hospitalized acutely ill patients over 40 years of age appears to be an efficient strategy using French cost data.