Health Economic Analysis of Thromboprophylaxis with Rivaroxaban and Certoparin-Sodium in Patients after Total Hip or Knee Replacement

Abstract

AIM: Postoperative deep venous thrombosis is a common complication after major orthopedic surgery. Standard prophylaxis is done by repetitive subcutaneous injections of low molecular heparin. However new oral anticoagulants became available for these indication in the last years. The aim of this prospective, comparing clinical observational study was to develop a modeling matrix considering all costs in order to allow a cost-benefit-analysis comparing anticoagulants in the post-operative administration. MATERIALS AND METHODS: Ninety patients after total hip or knee replacement participated in this study. They were randomly divided in two groups (group - rivaroxaban, group - certoparin-sodium). Quality of life was measured by PACT-Q Score. Also compliance was analyzed by Morisky-Score. Clinical and laboratory data as well as information on occurrence and reason of readmittance to the hospital were collected. RESULTS: The price per treatment dose of rivaroxaban is nearly two times higher compared to certoparin-sodium. In a hospital setting, a relevant part of the difference is offset by the costs for preparing the subcutaneous application of certoparin-sodium. No significant differences in clinical outcomes could be observed, but the results of the PACT-Q and the Morisky questionnaire showed clear advantages of the rivaroxaban group concerning patient treatment satisfaction and compliance. CONCLUSION: The present study gives an idea of the consequence of the quality of life on the total costs.