OBJECTIVES: To evaluate the cost-effectiveness of Dabigatran (DBG) compared to low-molecular-weight heparin (LMWH), for the prevention of venous thromboembolism (VTE) following total hip or knee replacement surgery (THR/TKR) from the perspective of the UK NHS.
METHODS: DBG (220 mg once daily) was compared to LMWH in patients undergoing THR (prophylaxis duration 28–35 days) and TKR (6–10 days). The 10-week post-surgery acute phase was modeled via a decision tree. A Markov process (1 year cycle length) modelled long-term events (recurrent VTE, post-thrombotic syndrome [PTS] and consequences of intracranial haemorrhage) for patient’s remaining lifetimes. Relative risks for VTE and bleed events were derived from the DBG phase III studies, RE-NOVATE and RE-MODEL which compared DBG with enoxaparin 40 mg once daily. Probabilities of long-term events were estimated from published longitudinal studies. Drug costs (for LMWH a weighted average was used), resource use associated with administration of prophylaxis and the management of clinical events, as well as utility weights, were taken from national sources and published literature.
RESULTS: Thromboprophylaxis with DBG was less costly than LMWH in TKR and substantially less in THR, since no nursing time is required either in hospital or following discharge for treatment administration. VTE and bleeding rates were similar for DBG and LMWH (all differences nonsignificant). The probabilistic analysis estimated that DBG saved £93 and £17 per patient on average in THR and TKR respectively; the probability of cost-effectiveness was 99% in THR and 81% in TKR at a willingness to pay threshold of £20,000 per QALY. Results were shown to be robust across a range of further sensitivity analyses.
CONCLUSIONS: DBG is cost-saving compared to LMWH and non-inferior in terms of efficacy and safety to enoxaparin 40 mg once daily. Therefore DBG can confidently be regarded as cost-effective for the prevention of VTE in patients undergoing THR or TKR.
