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Cost-effectiveness of enoxaparin versus aspirin in the prevention of venous thromboembolism after total hip or knee arthroplasty: an analysis from the CRISTAL cluster-randomized trial

Bone and Joint Journal, ISSN: 2049-4408, Vol: 106-B, Issue: 6, Page: 589-595
2024
  • 2
    Citations
  • 0
    Usage
  • 9
    Captures
  • 1
    Mentions
  • 0
    Social Media
Metric Options:   Counts1 Year3 Year

Metrics Details

  • Citations
    2
  • Captures
    9
  • Mentions
    1
    • News Mentions
      1
      • 1

Most Recent News

Reports Summarize Venous Thromboembolism Findings from Monash University (Cost-effectiveness of Enoxaparin Versus Aspirin In the Prevention of Venous Thromboembolism After Total Hip or Knee Arthroplasty: an Analysis From the Cristal ...)

2024 JUL 12 (NewsRx) -- By a News Reporter-Staff News Editor at Disease Prevention Daily -- Current study results on Cardiovascular Diseases and Conditions -

Article Description

Aims The aim of this study was to evaluate the healthcare costs and benefits of enoxaparin compared to aspirin in the prevention of symptomatic venous thromboembolism (VTE) after total hip arthroplasty (THA) or total knee arthroplasty (TKA) using data from the CRISTAL trial. Methods This trial-based economic analysis reports value for money as incremental cost per quality-adjusted life-year (QALY) gained in 2022 Australian dollars, compared to a single threshold value of AUD$70,000 per QALY. Event costs were estimated based on occurrence of VTEs and bleeds, and on published guidelines for treatment. Unit costs were taken from Australian sources. QALYs were estimated using CRISTAL six-month follow-up data. Sensitivity analyses are presented that vary the cost of VTE treatment, and extend the analyses to two years. Results The CRISTAL trial found that enoxaparin was more effective than aspirin in preventing symptomatic VTE within 90 days of THA or TKA (risk difference 1.97% (95% confidence interval (CI) 0.54% to 3.41%; p = 0.007)). The additional cost after a THA or TKA was AUD$83 (95% CI 68 to 97) for enoxaparin, and enoxaparin resulted in an additional 0.002 QALYs (95% CI -0.002 to 0.005). Incremental cost per QALY gained was AUD$50,567 (95% CI 15,513, dominated) for enoxaparin. We can be 60% confident that the incremental cost per QALY does not exceed the willingness-to-pay threshold of AUD$70,000. Increasing the cost of VTE treatment and extension of costs and consequences to two years suggested greater confidence that enoxaparin is good value for money (70% and 63% confidence, respectively). Conclusion This analysis provides strong evidence that enoxaparin thromboprophylaxis following THA or TKA reduced VTEs, but weak evidence of net economic benefits over aspirin. If the value of avoiding VTEs is high, and there is a strong likelihood of VTE-related health impairments, we can be more confident that enoxaparin is cost-effective compared to aspirin.

Bibliographic Details

Nicola Huxley; Verinder Sidhu; Thu Lan Kelly; Nicole L. Pratt; Stephen E. Graves; Rachelle Buchbinder; Sam Adie; Kara Cashman; Ilana Ackerman; Richard de Steiger; Michelle Lorimer; Justine M. Naylor; Ian A. Harris; Anthony Harris

British Editorial Society of Bone & Joint Surgery

Medicine

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