Menzin J, Colditz G A, Regan M M, Richner R E, Oster G
Policy Analysis Inc., Brookline, Mass.
Arch Intern Med. 1995 Apr 10;155(7):757-64.
Enoxaparin sodium, a low-molecular-weight heparin, was recently approved for use in the United States to prevent deep-vein thrombosis after total hip replacement surgery. Its cost-effectiveness relative to prophylaxis with low-dose warfarin sodium is unknown.
A decision-analytic model was developed to compare two strategies of prophylaxis for deep-vein thrombosis with a strategy of not using prophylaxis in a hypothetical cohort of 10,000 patients undergoing total hip replacement surgery. For each of these strategies, we estimated the expected number of cases of confirmed deep-vein thrombosis or pulmonary embolism, the expected number of thromboembolic deaths, and the expected costs of venous thromboembolic care, including prophylaxis, diagnosis, and treatment. Data were drawn primarily from the published literature.
Compared with no prophylaxis, the use of low-dose warfarin would be expected to reduce the number of cases of confirmed deep-vein thrombosis from about 1000 (per 10,000 patients) to 420 and the number of thromboembolic deaths from about 250 to 110. Expected costs of care related to deep-vein thrombosis also would be reduced from approximately $530 to $330 per patient. Prophylaxis with enoxaparin would be expected to reduce further the number of cases of confirmed deep-vein thrombosis and the number of thromboembolic deaths (to 250 and 70, respectively) but increase costs of care by approximately $50 per patient. The cost-effectiveness of enoxaparin (relative to low-dose warfarin) is estimated to be approximately $12,000 per death averted.
Although enoxaparin is more costly than low-dose warfarin, its cost-effectiveness in total hip replacement compares favorably with that of other generally accepted medical interventions.
依诺肝素钠，一种低分子量肝素，最近在美国被批准用于预防全髋关节置换术后深静脉血栓形成。其相对于低剂量华法林钠预防的成本效益尚不清楚。
建立了一个决策分析模型，以比较在一个假设的10000例接受全髋关节置换手术的患者队列中，两种深静脉血栓形成预防策略与不进行预防的策略。对于这些策略中的每一种，我们估计了确诊的深静脉血栓形成或肺栓塞病例的预期数量、血栓栓塞性死亡的预期数量以及静脉血栓栓塞护理的预期成本，包括预防、诊断和治疗。数据主要来自已发表的文献。
与不进行预防相比，使用低剂量华法林预计可将确诊的深静脉血栓形成病例数从约1000例（每10000例患者）减少至420例，血栓栓塞性死亡数从约250例减少至110例。与深静脉血栓形成相关的护理预期成本也将从每位患者约530美元降至330美元。依诺肝素预防预计可进一步减少确诊的深静脉血栓形成病例数和血栓栓塞性死亡数（分别降至250例和70例），但每位患者的护理成本增加约50美元。依诺肝素（相对于低剂量华法林）的成本效益估计约为每避免一例死亡12000美元。
尽管依诺肝素比低剂量华法林成本更高，但其在全髋关节置换中的成本效益与其他普遍接受的医学干预措施相比具有优势。
