OBJECTIVES: To estimate cost/effectiveness and cost/utility of dabigatran etexilate (DBG) compared to standard care for the prevention of venous thromboembolism (VTE) secondary to total hip replacement (THR) or total knee replacement (TKR) in Italy. METHODS: A decision analytic, Markov-chain based model originally developed for the UK has been adapted to the Italian context. Clinical outcomes, including incidences of VTE and treatment-related  adverse events, were extrapolated from head-to-head, phase III trials of DBG vs enoxaparin. For the other low molecular weight heparins (LMWHs), indirect comparisons were performed on the basis of equal effectiveness assumptions. The adaptation involved  cost and demographic characteristics, leaving  clinical and utility data unvaried. Costs are taken from national observational studies, where available. Otherwise, current prices and tariffs are applied.  Resources consumption where derived from practice guidelines or taken from those estimated for the UK model. According to the prevalent national practice, extended prophylaxis has been considered for both surgical procedures. Time horizon of the analysis is patients’ lifetime. RESULTS: Compared to LMWHs, DBG is associated to an expected increase of 0.019 LYs and 0.014 QALYs per THR patient and of 0.024 LYs and 0.019 QALYs per TKR patient. DBG-related cost is lower than competitors in both procedures, with a mean difference ranging between €82 and €109 for THR, and 100 and 135 for TKR, depending on the considered comparator. Higher acquisition costs for DBG are completely offset and inverted by avoided administration expenses and, less importantly, by savings on VTE management. Probabilistic sensitivity analysis estimates that, for a willingness to pay threshold of £30,000 (~€33,500)/QALY, DBG is associated to a probability of being cost/effective of about 98% for THR and of 90%  for TKR. CONCLUSIONS: On average DBG dominates LMWHs, as it’s expected to be cost-saving and non-inferior in terms of efficacy and safety.