VENOUS THROMBOEMBOLISM PROPHYLAXIS STRATEGIES FOR ELECTIVE TOTAL HIP REPLACEMENT SURGERY- SYSTEMATIC REVIEW, NETWORK META-ANALYSIS AND COST –UTILITY ANALYSIS TO INFORM NICE CLINICAL GUIDELINE RECOMMENDATION
Author(s)
Dawoud D1, Wonderling D2, Lewis S2, Glen J2, Dias S3, Cobb J2, Griffin X4, Reed M5, Rossiter N6, Stansby G7, Hunt BJ8, Chahal JK9, Sharpin C2, Barry P10
1University of Hertfordshire, Hatfield, UK, 2Royal College of Physicians, London, UK, 3University of Bristol, Bristol, UK, 4University of Oxford, Oxford, UK, 5Northumbria Healthcare NHS Foundation Trust, Newcastle upon Tyne, UK, 6Basingstoke & North Hampshire Hospital, Basingstoke, UK, 7University of Newcastle, Newcastle upon Tyne, UK, 8King's College London, London, UK, 9Barts Health NHS Trust, London, UK, 10University Hospitals of Leicester NHS Trust, Leicester, UK
OBJECTIVES: To assess the cost-effectiveness of venous thromboembolism (VTE) prophylaxis strategies for adults undergoing elective total hip replacement (eTHR), from the English National Health Service perspective (NHS), in order to inform NICE guideline NG89 recommendation. METHODS: Sixteen strategies were assessed. These included low molecular weight heparin (LMWH) in low, standard and high prophylactic doses, rivaroxaban, apixaban, dabigatran, aspirin and anti-embolism stockings. A systematic review (SR) of randomised controlled trials (RCTs) was undertaken. Efficacy and safety were assessed using network meta-analysis (NMA) of three outcomes: deep vein thrombosis (DVT), pulmonary embolism (PE) and major bleeding (MB). An economic model, consisting of decision tree followed by Markov model, was developed according to NICE reference case (lifetime time horizon, 3.5% discount rate for costs and quality-adjusted life-years (QALYs), incremental net monetary benefit (INMB) was calculated using a cost-effectiveness threshold of £20,000/QALY-gained). The cost year was 2015-2016. The model was run probabilistically. Additionally, one-way sensitivity analyses (SAs) were undertaken. Assumptions were discussed with and agreed by the NICE guideline committee members. RESULTS: Forty-two RCTs (n=24,374) were included in the SR. In the DVT network, rivaroxaban ranked first (RR=0.06, 95% credible interval (CrI): 0.0, 0.29). In both PE and MB networks, LMWH (standard-dose) for 10 days followed by aspirin (low-dose) for 28 days ranked first (RR=0.0011 [0.00,-0.096] and OR=0.37 [0.00, 26.96], respectively). The most cost-effective strategy was LMWH (standard-dose) for 10 days followed by aspirin (low-dose) for 28 days (INMB=£530 [95% CI:-£784, £1,103], probability of being the most cost-effective=72%). The optimal strategy did not change in any SA. CONCLUSIONS: In people undergoing eTHR, a VTE prophylaxis strategy consisting of LMWH (standard dose) for 10 days followed by aspirin for 28 days was the most cost-effective from the English NHS perspective.
Conference/Value in Health Info
2018-11, ISPOR Europe 2018, Barcelona, Spain
Value in Health, Vol. 21, S3 (October 2018)
Code
PCV90
Topic
Economic Evaluation
Topic Subcategory
Cost-comparison, Effectiveness, Utility, Benefit Analysis
Disease
Cardiovascular Disorders
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