FONDAPARINUX FOR ISOLATED SUPERFICIAL-VEIN THROMBOSIS OF THE LEGS: A COST-EFFECTIVENESS ANALYSIS.
Chest. 2011 Jul 14;
Authors: Blondon M, Righini M, Bounameaux H, Veenstra DL
ABSTRACT BACKGROUND: According to a recent randomized controlled trial (CALISTO), prophylactic fondaparinux can prevent thrombotic complications following superficial vein thrombosis (SVT). The cost-effectiveness of this treatment remains to be determined. METHODS: We developed a decision tree model comparing fondaparinux 2.5 mg daily for 45 days versus no treatment for SVT. It included all clinical events associated with SVT, its treatment , complications, and all respective quality-adjustment factors Data were mainly derived from the CALISTO study and the published literature. Measured outcomes comprised clinical events (venous thromboembolism (VTE), major hemorrhage, death), quality-adjusted life-years (QALYs), costs, and incremental cost-effectiveness ratios (ICER). The analysis was conducted with a lifetime time horizon from a health care system perspective. We performed one-way and probabilistic sensitivity analyses to evaluate parameter uncertainty. RESULTS: In 10,000 patients, we estimated that fondaparinux would prevent 123 VTE events and 2 deaths. On a per-patient basis, the incremental QALY compared to no treatment was 0.04 (1 day) at an incremental cost of $1734, resulting in an ICER of $500,000/QALY. This result remained robust in the one-way sensitivity analyses, with an ICER remaining above $100,000/QALY throughout all ranges. Based on probabilistic sensitivity analyses, the probability that fondaparinux was cost-effective was 1% at a willingness-to-pay of $100,000/QALY. CONCLUSION: Fondaparinux for 45 days does not appear to be cost-effective when used in all patients with isolated SVT of the legs. A better value for money could be obtained in subgroups of patients with a higher incidence of VTE after SVT. Shorter durations of treatment should be further evaluated in future clinical studies.
PMID: 21757569 [PubMed - as supplied by publisher]