Thromboprophylaxis and Total Hip Replacement: A Cost-Efficacy Study Comparing Duplex Screening of Asymptomatic Venous Thrombosis versus Prolonged Prophylaxis with Low-Molecular-Weight Heparins

Abstract

Background:

Despite use of the anti-thrombotic prophylaxis, clinical thrombo-embolic events and fatal pulmonary embolism are still observed after total hip replacement. To reduce these complications, two strategies have been adopted: to prolong the use of low-molecular-weight heparins (LMWH) to 35 days or to screen patients systematically before discharge, using duplex ultrasonography, following the short-course prophylactic treatment.

Objective:

To assess, based on published literature, the relative costs and benefits of these two strategies for prophylaxis following total hip arthroplasty.

Method:

The author identified relevant papers in this field from his own resources and from medical literature databases.

Synthesis:

Prolonging LMWH treatment to a total of 35 days represents a direct cost in France of approximately £340 per patient, or for 100000 total hip replacements per year, an annual budget of £34 000000. If this strategy attained maximum efficacy, it would avoid 150 fatal pulmonary embolisms. The direct cost would therefore be at least £227000 per life saved. A systematic single duplex ultrasound examination before discharge from hospital would cost £76 per patient, or for 100 000 arthroplasties a total annual budget in France of £7 600000. If this approach achieved maximum efficacy, preventing the 150 fatal pulmonary embolisms corresponding to 100000 total hip replacements, the minimum direct cost would be £50 300 per life saved.

Conclusion:

Duplex screening may be more effective and lest costly than prolongation of prophylactic treatment using LMWH. This deduction needs to be confirmed by complex cost-benefit studies using clinical end-points.