Michael Lees

Economic burden of venous thromboembolism: a systematic review.

Abstract Objective: Deep vein thrombosis and pulmonary embolism – together referred to as venous thromboembolism (VTE) – result in a major burden on healthcare systems. However, to the authors’ knowledge no comprehensive review of the economic burden of VTE has so far been published. Methods: A literature search was carried out to identify references published in English since 1997 using Medline, the Cochrane Library and the Health Economic Evaluations Database. The primary outcomes of interest were ‘all-cause’ VTE and VTE after major orthopedic surgery. Results: A total of 1,037 full research articles and abstracts were screened for inclusion in the review. Of these, ten cost-of-illness studies were identified that met the inclusion criteria and are included in the current review. The results of large US database analyses vary, indicating costs of the initial VTE of approximately US

Cost Effectiveness of Rivaroxaban versus Enoxaparin for Prevention of Post-Surgical Venous Thromboembolism from a US Payer’s Perspective

3,000–9,500. The total costs related to VTE over 3 months (US

Clinical burden of venous thromboembolism

5,000), 6 months (US

An indirect comparison, via enoxaparin, of rivaroxaban with dabigatran in the prevention of venous thromboembolism after hip or knee replacement.

10,000) and 1 year (US

Cost and outcomes associated with rivaroxaban vs enoxaparin for the prevention of postsurgical venous thromboembolism from a US payer’s perspective

33,000) were considerable. Studies conducted in the European Union indicate lower additional inpatient costs after VTE of €1,800 after 3 months and €3,200 after 1 year, which still represent a considerable impact on healthcare systems. Complications after VTE can be very expensive, with estimates of the additional cost of treating the post-thrombotic syndrome ranging from

Economic impact of venous thromboembolism after hip and knee arthroplasty: potential impact of rivaroxaban

426 to

PHC7 COST-EFFECTIVENESS OF RIVAROXABANVERSUS ENOXAPARIN FORTHROMBOPROPHYLAXIS AFTER TOTAL HIP REPLACEMENT IN CANADA

11,700 and heparin-induced thrombocytopenia from

Indirect Comparisons of Rivaroxaban Versus Alternative Prophylaxes for the Prevention of VTE in Patients Undergoing Total Knee Replacement.

3,118 to

Brief review Economic burden of venous thromboembolism: a systematic review

41,133. A limitation of studies using older data is that recent changes in the treatment of VTE may affect the generalizability of these findings. Conclusions: Complications associated with VTE are frequent and costly. In particular, the cost of complications resulting from prophylaxis and treatment of VTE, such as post-thrombotic syndrome and heparin-induced thrombocytopenia, had a considerable economic impact.

Review Clinical burden of venous thromboembolism

AbstractBackground: Major orthopaedic surgery, such as total hip replacement (THR) and total knee replacement (TKR), is associated with an increased risk of venous thromboembolism (VTE). Objective: Clinical trials have demonstrated the efficacy of rivaroxaban, a oncedaily, orally administered Factor Xa inhibitor, for the prevention of VTE in patients undergoing THR or TKR. This analysis evaluated the cost effectiveness of rivaroxaban compared with enoxaparin, from a US payer’s perspective. Methods: A decision-analytic model was developed to compare the costs and outcomes associated with rivaroxaban and enoxaparin for the prevention of VTE. The model replicated short-term clinical outcomes from the phase III RECORD trials.RECORD1 and RECORD2 compared rivaroxaban 10mg daily (qd), given for 35 days, with enoxaparin 40mg qd, given for 35 days or 10 to 14 days, respectively, in patients undergoing THR. RECORD3 compared 10 mg of rivaroxaban qd for 10 to 14 days versus 40 mg of enoxaparin qd for 10 to 14 days in patients undergoing TKR. The decision-analytic model also included data on long-term complications and sequelae as captured in observational studies and databases. It also included direct year 2010 medical costs over 1-year and 5-year time horizons. A series of sensitivity analyses were performed to determine the impact of different factors on the results of the model. Results of the cost-effectiveness analysis were reported in terms of symptomatic VTE events avoided. Results: Rivaroxaban was associated with cost savings of