Cost Analysis of Thromboprophylaxis in Patients at High Thromboembolic Risk with Enoxaparin, Dalteparin and Nadroparin in Colombia: A Systematic Literature Review-Based Study.

Abstract

Purpose: To analyze the costs of high thromboembolic risk patients who require low molecular weight heparins (LMWHs) as a thromboprophylaxis strategy.

Methods: Cost analysis was conducted to assess LMWHs (enoxaparin versus comparators: nadroparin and dalteparin) as thromboprophylaxis for hospitalized patients with high thromboembolic risk in Oncology, General or Orthopedic Surgery, and Internal Medicine services from the healthcare provider's perspective in Colombia. A decision tree was developed, and the health outcomes considered in the analysis were deep vein thrombosis, major bleeding, pulmonary thromboembolism, and chronic pulmonary hypertension. Clinical inputs were obtained from a systematic review of the literature and the economic parameters from micro-costing. Inputs were validated by three clinical experts. Costs were expressed in 2020 US dollars (USD).

Results: In a hypothetical cohort of 10,000 patients with a thromboprophylaxis use rate of 40%, the use of enoxaparin was less costly than that of dalteparin in Oncology (difference of USD 624,669), Orthopedic Surgery (difference of USD 275,829), and Internal Medicine (difference of USD 109,119) patients. For these services, using enoxaparin was more efficient than using nadroparin (cost differences of USD 654,069, USD 416,927, and USD 92,070, respectively). Sensitivity analysis showed an important influence of the number of patients undergoing thromboprophylaxis, as well as the unit cost, and the risk of events (DVT, PTE, and CTEPH).

Conclusion: Enoxaparin is the least expensive health technology for thromboprophylaxis in most of the medical contexts analyzed in Colombia due to its efficacy and the lower risk of complications than dalteparin and nadroparin.