Economic evaluations of anticoagulants for the prophylaxis of venous thromboembolism following major trauma

Abstract

Venous thromboembolism is a life-threatening complication in patients following major trauma. These patients are at increased risk of deep-vein thrombosis and pulmonary embolism. In the absence of a major contraindication, anticoagulant prophylaxis with either low-dose unfractionated heparin or low-molecular-weight heparin is recommended. The objectives of this study were to undertake a systematic review and critically evaluate published cost–effectiveness analyses of anticoagulant prophylaxis against deep-vein thrombosis following major trauma. The results of the identified studies varied significantly, from enoxaparin being the dominant strategy based on the cost-per-deep-vein thrombosis averted, to low-dose unfractionated heparin being the dominant strategy based on the cost per life-year gained. In general, the more comprehensive the model, the more favorable the results were towards low-dose unfractionated heparin.

Keywords::

• cost–effectiveness
• deep-vein thrombosis
• economics
• enoxaparin
• heparin
• low-molecular-weight heparin
• prophylaxis
• pulmonary embolism
• thromboembolism
• venous thrombosis

Acknowledgements

Dean Regier is funded by a Canadian Institutes of Health Research (CIHR) Doctoral Research Award and by a University of Aberdeen studentship. Lynd and Marra are Michael Smith Foundation for Health Research Scholars. Lynd is a CIHR New Investigator and Marra hold a Canada Research Chair in Pharmaceutical Outcomes.

Financial disclosure

The authors have no relevant financial interests, including employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties related to this manuscript.