OBJECTIVES A high risk to develop pulmonary thromboembolism (PE) and deep vein thrombosis (DVT) has been associated with certain surgeries and prolonged hospitalization. The aim of this study was to assess the cost-effectiveness of different anticoagulant therapies to prevent or treat VTE associated with hip surgery from the health care payer's perspective. METHODS A six-state stochastic Markov model was performed to estimate costs and effectiveness during a time horizon of one-year (1-week cycles). Effectiveness measures were reduction in PE and DVT events; decreased hospitalizations and avoidance of death. Transition probabilities were obtained from a meta-analysis involving national and international published literature. Comparators used in the assessment were warfarin(5mg/day); dalteparin(2500,5000,7500IU/day); acenocoumarol(4mg/day); enoxaparin(20,40,60mg/day); nadroparin(5700IU/day); unfractionated heparin plus warfarin(10000,30000,42000IU/day+5mg/day) and fondaparinux(2.5-7.5mg/day). Resource use and costs were obtained from hospital records (n=8000) from the Social Security Mexican Institute (IMSS) and official institutional databases. Costs include outpatient and inpatient services, drug, procedures, etc. The model was validated according to international guidelines. Sensitivity analyses were performed employing bootstrapping techniques and acceptability curves were constructed. RESULTS Incidence of PE and DVT were significantly lower in patients receiving dalteparin treatment (p<0.05). Regarding the reduction of DVT events, dalteparin 2500, 5000 and 7000 IU/day showed an ICER[CI95%] of US$214.02[US$209.47-US$218.58]; US$198.65[US$194.43-US$202.89] and US$189.06[US$185.04-US$193.09] against warfarin, respectively. Dalteparin showed the lowest number of deaths and hospital re-admissions when compared to other anticoagulant treatments(p<0.05) reducing significant costs in the short term within an institutional Mexican setting. Second-order Monte Carlo analyses showed evidence that dalteparin would be more cost-effective than enoxaparin in a range of 60%-70%(p<0.05). CONCLUSIONS In Mexico, dalteparin demonstrated to be a cost-effective anticoagulant therapy to reduce the incidence of PE and DVT, and avoid death and hospital re-admissions in the management of adult patients after total hip replacement. These results should be taken into account by Mexican health professionals to generate cost-containment strategies.