Economic Impact of Venous Thromboembolism After Hip and Knee Arthroplasty

Potential Impact of Rivaroxaban

Richard J Friedman; Nishan Sengupta; Michael Lees

Disclosures

Expert Rev Pharmacoeconomics Outcomes Res. 2011;11(3):299-306. 

In This Article

Abstract and Introduction

Abstract

The number of total hip and knee arthroplasties is increasing, with a consequent rise in the number of patients at risk of venous thromboembolism. Each such event is associated with the risk of morbidity and mortality, plus substantial healthcare costs. Consequently, the American College of Chest Physicians guidelines recommend low-molecular-weight heparins, fondaparinux or vitamin K antagonists (usually warfarin) after total hip and knee arthroplasty. However, such agents are also associated with healthcare costs for administration and monitoring. New oral anticoagulants in development may reduce post-arthroplasty symptomatic thromboembolic events and produce potential savings for the healthcare system. This brief article outlines such potential savings with rivaroxaban based on the results of the REgulation of Coagulation in ORthopaedic surgery to prevent Deep vein thrombosis and pulmonary embolism (RECORD) program.

Introduction

In 2005, approximately 285,000 total hip arthroplasties (THAs) and 523,000 total knee arthroplasties (TKAs) were performed in the USA.[1] As the US population ages, these figures will rise, and by 2030 the demand for THA is estimated to grow to 572,000 and for TKA to 3,481,000.[2] One of the complications after THA and TKA is venous thromboembolism (VTE), which comprises deep-vein thrombosis (DVT) and pulmonary embolism (PE). Patients undergoing THA are at a high risk of asymptomatic DVT (incidence 40–60%) and symptomatic VTE (incidence 2–5%)[3] in the absence of prophylaxis, and the risk is even higher after TKA.[3] DVT can result in morbidity and mortality and, if thromboprophylaxis is not used, fatal PE occurs in approximately one patient per 300 undergoing THA.[3] Nonfatal PE can also have considerable consequences and may result in chronic pulmonary hypertension.[4,5] VTE treatment is also associated with significant cost implications for the US healthcare system.[6] Current guidelines recommend the routine use of established anticoagulants for the prevention of VTE after THA and TKA:[3] either low-molecular-weight heparins (LMWHs), fondaparinux or adjusted-dose vitamin K antagonists (usually warfarin).

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