School of Medicine and Health Sciences Poster Presentations
Poster Number
268
Document Type
Poster
Status
Medical Student
Abstract Category
Health Services
Keywords
Cost-effectiveness, total knee arthroplasty, anticoagulation, deep vein thrombosis, Markov modeling
Publication Date
Spring 2018
Abstract
Background: Anticoagulation is essential for deep vein thrombosis (DVT) and pulmonary embolism (PE) prevention following total knee arthroplasty (TKA). Some research has suggested that longer duration anticoagulation can substantially reduce the risks of DVT and PE; however, in the absence of definitive recommendations, physicians are left weighing the risks of DVT and PE against those of anticoagulation, including gastrointestinal (GI) and central nervous system (CNS) hemorrhage and increased likelihood of prosthetic joint infection (PJI). We conducted a cost-effectiveness analysis to evaluate the benefits and risks of 14- and 35-day therapy with the most commonly prescribed anticoagulants post-TKA.
Background: Anticoagulation is essential for deep vein thrombosis (DVT) and pulmonary embolism (PE) prevention following total knee arthroplasty (TKA). Some research has suggested that longer duration anticoagulation can substantially reduce the risks of DVT and PE; however, in the absence of definitive recommendations, physicians are left weighing the risks of DVT and PE against those of anticoagulation, including gastrointestinal (GI) and central nervous system (CNS) hemorrhage and increased likelihood of prosthetic joint infection (PJI). We conducted a cost-effectiveness analysis to evaluate the benefits and risks of 14- and 35-day therapy with the most commonly prescribed anticoagulants post-TKA.
Results: Aspirin resulted in the highest cumulative incidence of DVT and PE, while prolonged fondaparinux led to the largest reduction in DVT incidence (15% reduction compared to no prophylaxis). Despite differential bleeding rates (ranging from 3% to 6%), all strategies had similar incidence of PJI (1-2%). Prolonged rivaroxaban was the least costly strategy ($3,300 one year post-TKA) and the preferred regimen in the base case. In sensitivity analyses, prolonged rivaroxaban and prolonged warfarin had similar likelihoods of being cost-effective.
Conclusions: For all anticoagulants, extending the duration of anticoagulation therapy in the post-operative period to 35 days increases QALYs compared to standard 14-day prophylaxis. Prolonged rivaroxaban and prolonged warfarin are most likely to be cost-effective in TKA patients; the costs of fondaparinux and LMWH precluded their being preferred strategies. As warfarin and rivaroxaban are comparable from a cost-effectiveness standpoint, patient preferences can help inform the appropriate post-TKA prophylaxis.
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Open Access
1
Cost-Effectiveness of Alternative Anticoagulation Strategies for Postoperative Management of Total Knee Arthroplasty Patients
Background: Anticoagulation is essential for deep vein thrombosis (DVT) and pulmonary embolism (PE) prevention following total knee arthroplasty (TKA). Some research has suggested that longer duration anticoagulation can substantially reduce the risks of DVT and PE; however, in the absence of definitive recommendations, physicians are left weighing the risks of DVT and PE against those of anticoagulation, including gastrointestinal (GI) and central nervous system (CNS) hemorrhage and increased likelihood of prosthetic joint infection (PJI). We conducted a cost-effectiveness analysis to evaluate the benefits and risks of 14- and 35-day therapy with the most commonly prescribed anticoagulants post-TKA.
Background: Anticoagulation is essential for deep vein thrombosis (DVT) and pulmonary embolism (PE) prevention following total knee arthroplasty (TKA). Some research has suggested that longer duration anticoagulation can substantially reduce the risks of DVT and PE; however, in the absence of definitive recommendations, physicians are left weighing the risks of DVT and PE against those of anticoagulation, including gastrointestinal (GI) and central nervous system (CNS) hemorrhage and increased likelihood of prosthetic joint infection (PJI). We conducted a cost-effectiveness analysis to evaluate the benefits and risks of 14- and 35-day therapy with the most commonly prescribed anticoagulants post-TKA.
Results: Aspirin resulted in the highest cumulative incidence of DVT and PE, while prolonged fondaparinux led to the largest reduction in DVT incidence (15% reduction compared to no prophylaxis). Despite differential bleeding rates (ranging from 3% to 6%), all strategies had similar incidence of PJI (1-2%). Prolonged rivaroxaban was the least costly strategy ($3,300 one year post-TKA) and the preferred regimen in the base case. In sensitivity analyses, prolonged rivaroxaban and prolonged warfarin had similar likelihoods of being cost-effective.
Conclusions: For all anticoagulants, extending the duration of anticoagulation therapy in the post-operative period to 35 days increases QALYs compared to standard 14-day prophylaxis. Prolonged rivaroxaban and prolonged warfarin are most likely to be cost-effective in TKA patients; the costs of fondaparinux and LMWH precluded their being preferred strategies. As warfarin and rivaroxaban are comparable from a cost-effectiveness standpoint, patient preferences can help inform the appropriate post-TKA prophylaxis.
Comments
Presented at GW Annual Research Days 2018.