OBJECTIVES:  Premature death due to pulmonary embolism is a short-term complication of venous thromboembolism (VTE). The long-term clinical course after VTE can be further complicated by excess mortality, recurrent VTE, Chronic thromboembolic pulmonary hypertension (CTEPH) and the post-thrombotic syndrome (PTS), all of which may produce sizable long-term economic burdens. The cost-effectiveness of thromboprophylaxis with enoxaparin versus no prophylaxis has been established in other countries. The aim of this study was to evaluate the cost-effectiveness of enoxaparin in Chinese patients after general surgery with comparison of no prophylaxis. METHODS:  A decision model, which included both the acute VTE (represented as a decision tree) and the long-term complications (represented as a Markov model), was developed to assess economic outcomes of the two strategies for Chinese patients after general surgery. Transition probabilities related to VTE, categorized by Caprini score (the VTE risk assessment model which is well accepted by international and Chinese clinical guideline), were derived from published literature. Costs and utilities were derived from published literature and local healthcare settings. One-way and probabilistic sensitivity analyses were performed to test the uncertainty concerning the model parameters. Quality-adjusted life year (QALY) and direct medical costs were measured over a five-year horizon. Incremental cost-effectiveness ratios (ICERs) were calculated. RESULTS:  Comparing with no prophylaxis, thromboprophylaxis with enoxaparin gained additional 0.010, 0.014, 0.030 and 0.072 QALYs in patients with Caprini score 3-4, 5-6, 7-8 and ≥9, respectively. In Caprini score 3-4 and 5-6, the ICER of enoxaparin versus no prophylaxis was ¥9,834 and ¥2,190 per QALY gained when enoxaparin used for 7 days. In Caprini score 7-8 and ≥9, thromboprophylaxis with enoxaparin was dominant. Sensitivity analyses confirmed the results. CONCLUSIONS:  The study suggests that thromboprophylaxis with enoxaparin is a cost-effective intervention for all VTE risk levels in patients undergoing general surgery in China.