Economic evaluation of the use of nadroparin calcium in the prophylaxis of deep vein thrombosis and pulmonary embolism in surgical patients in Italy

The objective of this study was to compare the costs, from the perspective of the payer, of using nadroparin calcium, a low-molecular-weight heparin, instead of unfractionated heparin in the prophylaxis of venous thromboembolism in patients undergoing orthopaedic surgery or major general surgery in Italy. The methods used were based on a published meta-analysis and a survey of clinical practice. We constructed a model of the prophylaxis and management of venous thromboembolism in Italy. Resource use associated with individual events was estimated on the basis of the clinical survey. Unit costs, not available from published sources, were taken from charges made by hospitals and from direct observation. A sensitivity analysis was conducted to examine whether the results were robust to changes in key variables. In the base case, compared with unfractionated heparin, prophylaxis with nadroparin calcium reduced the expected costs of managing thromboembolism by 267 226 Italian lire (L, 1994 values; $US1 = L1600 approx.) per patient undergoing orthopaedic surgery, and by L45 588 per patient undergoing major general surgery. Therefore, switching from unfractionated heparin to nadroparin calcium in these patients offers the possibility of significant cost savings to the Italian healthcare system.