University of Hertfordshire

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Cost-Utility Analysis of Venous Thromboembolism Prophylaxis Strategies for People Undergoing Elective Total Hip and Total Knee Replacement Surgeries in the English National Health Service. / Dawoud, Dalia M; Wonderling, David; Glen, Jessica; Lewis, Sedina; Griffin, Xavier; Hunt, Beverley J; Stansby, Gerard; Reed, Michael; Rossiter, Nigel ; Chahal, Jagjot; Sharpin, Carlos; Barry, Peter.

In: Frontiers in Pharmacology, Vol. 9, No. NOV, 1370, 27.11.2018.

Research output: Contribution to journalArticlepeer-review

Harvard

Dawoud, DM, Wonderling, D, Glen, J, Lewis, S, Griffin, X, Hunt, BJ, Stansby, G, Reed, M, Rossiter, N, Chahal, J, Sharpin, C & Barry, P 2018, 'Cost-Utility Analysis of Venous Thromboembolism Prophylaxis Strategies for People Undergoing Elective Total Hip and Total Knee Replacement Surgeries in the English National Health Service', Frontiers in Pharmacology, vol. 9, no. NOV, 1370. https://doi.org/10.3389/fphar.2018.01370

APA

Dawoud, D. M., Wonderling, D., Glen, J., Lewis, S., Griffin, X., Hunt, B. J., Stansby, G., Reed, M., Rossiter, N., Chahal, J., Sharpin, C., & Barry, P. (2018). Cost-Utility Analysis of Venous Thromboembolism Prophylaxis Strategies for People Undergoing Elective Total Hip and Total Knee Replacement Surgeries in the English National Health Service. Frontiers in Pharmacology, 9(NOV), [1370]. https://doi.org/10.3389/fphar.2018.01370

Vancouver

Author

Dawoud, Dalia M ; Wonderling, David ; Glen, Jessica ; Lewis, Sedina ; Griffin, Xavier ; Hunt, Beverley J ; Stansby, Gerard ; Reed, Michael ; Rossiter, Nigel ; Chahal, Jagjot ; Sharpin, Carlos ; Barry, Peter. / Cost-Utility Analysis of Venous Thromboembolism Prophylaxis Strategies for People Undergoing Elective Total Hip and Total Knee Replacement Surgeries in the English National Health Service. In: Frontiers in Pharmacology. 2018 ; Vol. 9, No. NOV.

Bibtex

@article{17e4815ab56b48ecb804a2e2a8ac0ab8,
title = "Cost-Utility Analysis of Venous Thromboembolism Prophylaxis Strategies for People Undergoing Elective Total Hip and Total Knee Replacement Surgeries in the English National Health Service",
abstract = "Background: Major orthopedic surgery, such as elective total hip replacement (eTHR) and elective total knee replacement (eTKR), are associated with a higher risk of venous thromboembolism (VTE) than other surgical procedures. Little is known, however, about the cost-effectiveness of VTE prophylaxis strategies in people undergoing these procedures. Aim: The aim of this work was to assess the cost-effectiveness of these strategies from the English National Health Service perspective to inform NICE guideline (NG89) recommendations. Materials and Methods: Cost-utility analysis, using decision modeling, was undertaken to compare 15 VTE prophylaxis strategies for eTHR and 12 for eTKR, in addition to “no prophylaxis” strategy. The analysis complied with the NICE Reference Case. Structure and assumptions were agreed with the guideline committee. Incremental net monetary benefit (INMB) was calculated, vs. the model comparator (LMWH+ antiembolism stockings), at a threshold of £20,000/quality-adjusted life-year (QALY) gained. The model was run probabilistically. Deterministic sensitivity analyses (SAs) were undertaken to assess the robustness of the results. Results: The most cost-effective strategies were LMWH for 10 days followed by aspirin for 28 days (INMB = £530 [95% CI: -£784 to £1,103], probability of being most cost-effective = 72%) for eTHR, and foot pump (INMB = £353 [95% CI: -£101 to £665]; probability of being most cost-effective = 18%) for eTKR. There was considerable uncertainty regarding the cost-effectiveness ranking in the eTKR analysis. The results were robust to change in all SAs. Conclusions: For eTHR, LMWH (standard dose) for 10 days followed by aspirin for 28 days is the most cost-effective VTE prophylaxis strategy. For eTKR, the results are highly uncertain but foot pump appeared to be the most cost-effective strategy, followed closely by aspirin (low dose). Future research should focus on assessing cost-effectiveness of VTE prophylaxis in the eTKR population.",
keywords = "Cost utility analysis (CUA), Direct-acting oral anticoagulants, NICE guideline, Pharmacoeconomics, Total hip replacement (THR), Total knee replacement (TKR), Venous thromboembolism (VTE) prophylaxis",
author = "Dawoud, {Dalia M} and David Wonderling and Jessica Glen and Sedina Lewis and Xavier Griffin and Hunt, {Beverley J} and Gerard Stansby and Michael Reed and Nigel Rossiter and Jagjot Chahal and Carlos Sharpin and Peter Barry",
year = "2018",
month = nov,
day = "27",
doi = "10.3389/fphar.2018.01370",
language = "English",
volume = "9",
journal = "Frontiers in Pharmacology",
issn = "1663-9812",
publisher = "Frontiers Media S.A.",
number = "NOV",

}

RIS

TY - JOUR

T1 - Cost-Utility Analysis of Venous Thromboembolism Prophylaxis Strategies for People Undergoing Elective Total Hip and Total Knee Replacement Surgeries in the English National Health Service

AU - Dawoud, Dalia M

AU - Wonderling, David

AU - Glen, Jessica

AU - Lewis, Sedina

AU - Griffin, Xavier

AU - Hunt, Beverley J

AU - Stansby, Gerard

AU - Reed, Michael

AU - Rossiter, Nigel

AU - Chahal, Jagjot

AU - Sharpin, Carlos

AU - Barry, Peter

PY - 2018/11/27

Y1 - 2018/11/27

N2 - Background: Major orthopedic surgery, such as elective total hip replacement (eTHR) and elective total knee replacement (eTKR), are associated with a higher risk of venous thromboembolism (VTE) than other surgical procedures. Little is known, however, about the cost-effectiveness of VTE prophylaxis strategies in people undergoing these procedures. Aim: The aim of this work was to assess the cost-effectiveness of these strategies from the English National Health Service perspective to inform NICE guideline (NG89) recommendations. Materials and Methods: Cost-utility analysis, using decision modeling, was undertaken to compare 15 VTE prophylaxis strategies for eTHR and 12 for eTKR, in addition to “no prophylaxis” strategy. The analysis complied with the NICE Reference Case. Structure and assumptions were agreed with the guideline committee. Incremental net monetary benefit (INMB) was calculated, vs. the model comparator (LMWH+ antiembolism stockings), at a threshold of £20,000/quality-adjusted life-year (QALY) gained. The model was run probabilistically. Deterministic sensitivity analyses (SAs) were undertaken to assess the robustness of the results. Results: The most cost-effective strategies were LMWH for 10 days followed by aspirin for 28 days (INMB = £530 [95% CI: -£784 to £1,103], probability of being most cost-effective = 72%) for eTHR, and foot pump (INMB = £353 [95% CI: -£101 to £665]; probability of being most cost-effective = 18%) for eTKR. There was considerable uncertainty regarding the cost-effectiveness ranking in the eTKR analysis. The results were robust to change in all SAs. Conclusions: For eTHR, LMWH (standard dose) for 10 days followed by aspirin for 28 days is the most cost-effective VTE prophylaxis strategy. For eTKR, the results are highly uncertain but foot pump appeared to be the most cost-effective strategy, followed closely by aspirin (low dose). Future research should focus on assessing cost-effectiveness of VTE prophylaxis in the eTKR population.

AB - Background: Major orthopedic surgery, such as elective total hip replacement (eTHR) and elective total knee replacement (eTKR), are associated with a higher risk of venous thromboembolism (VTE) than other surgical procedures. Little is known, however, about the cost-effectiveness of VTE prophylaxis strategies in people undergoing these procedures. Aim: The aim of this work was to assess the cost-effectiveness of these strategies from the English National Health Service perspective to inform NICE guideline (NG89) recommendations. Materials and Methods: Cost-utility analysis, using decision modeling, was undertaken to compare 15 VTE prophylaxis strategies for eTHR and 12 for eTKR, in addition to “no prophylaxis” strategy. The analysis complied with the NICE Reference Case. Structure and assumptions were agreed with the guideline committee. Incremental net monetary benefit (INMB) was calculated, vs. the model comparator (LMWH+ antiembolism stockings), at a threshold of £20,000/quality-adjusted life-year (QALY) gained. The model was run probabilistically. Deterministic sensitivity analyses (SAs) were undertaken to assess the robustness of the results. Results: The most cost-effective strategies were LMWH for 10 days followed by aspirin for 28 days (INMB = £530 [95% CI: -£784 to £1,103], probability of being most cost-effective = 72%) for eTHR, and foot pump (INMB = £353 [95% CI: -£101 to £665]; probability of being most cost-effective = 18%) for eTKR. There was considerable uncertainty regarding the cost-effectiveness ranking in the eTKR analysis. The results were robust to change in all SAs. Conclusions: For eTHR, LMWH (standard dose) for 10 days followed by aspirin for 28 days is the most cost-effective VTE prophylaxis strategy. For eTKR, the results are highly uncertain but foot pump appeared to be the most cost-effective strategy, followed closely by aspirin (low dose). Future research should focus on assessing cost-effectiveness of VTE prophylaxis in the eTKR population.

KW - Cost utility analysis (CUA)

KW - Direct-acting oral anticoagulants

KW - NICE guideline

KW - Pharmacoeconomics

KW - Total hip replacement (THR)

KW - Total knee replacement (TKR)

KW - Venous thromboembolism (VTE) prophylaxis

UR - http://www.scopus.com/inward/record.url?scp=85057795498&partnerID=8YFLogxK

U2 - 10.3389/fphar.2018.01370

DO - 10.3389/fphar.2018.01370

M3 - Article

VL - 9

JO - Frontiers in Pharmacology

JF - Frontiers in Pharmacology

SN - 1663-9812

IS - NOV

M1 - 1370

ER -