Mamdani MM, Weingarten CM, Stevenson JG.
Thromboembolic prophylaxis in moderate-risk patients undergoing elective
abdominal surgery: decision and cost-effectiveness analyses.
Pharmacotherapy 1996 Nov-Dec;16(6):1111-27

College of Pharmacy and Allied Health Professions, Wayne State University,
Detroit, Michigan, USA.

We conducted a retrospective, literature-based decision analysis to compare the
cost-effectiveness of conventional low-dose heparin, dalteparin, and intermittent
pneumatic compression (IPC) as thromboembolic prophylaxis to a no-prophylaxis
option in patients at moderate risk of developing thromboembolic complications
after major elective abdominal surgery. The analysis was conducted through an
institutional perspective. Probability and incidence rate data were summarized
from the literature. Cost data were obtained from the Detroit Medical Center's
cost accounting systems and from national diagnosis-related group estimates.
Mortality and complications avoided were the main outcome measures on which
cost-effectiveness was based. Overall costs associated with conventional low-dose
heparin, dalteparin, intermittent pneumatic compression, and no prophylaxis were
$84, $122, $102, and $112, respectively in the primary analysis, which included
costs of labor. Corresponding cost-effectiveness ratios in terms of
costs/complication-free patient were $86, $124, $103, and $118, respectively.
Compared with no prophylaxis, incremental cost-effectiveness analysis in terms of
cost/mortality avoided involved savings of $6087 and $3125 with conventional
low-dose heparin and IPC, respectively, and expenses of $2857 with dalteparin. A
secondary analysis excluding costs of labor showed similar results. The results
of the study consistently showed conventional low-dose heparin to provide the
most cost-effective thromboembolic prophylaxis of the methods considered in terms
of reducing both morbidity and mortality in the patient population studied.