Skip to main content
SpringerLink
Log in

Cost Effectiveness of Venous Thromboembolism Pharmacological Prophylaxis in Total Hip and Knee Replacement

A Systematic Review

  • Review Article
  • Published:
PharmacoEconomics Aims and scope Submit manuscript

Abstract

Total hip and knee replacements (THR and TKR) are high-risk settings for venous thromboembolism (VTE). This review summarizes the cost effectiveness of VTE prophylaxis regimens for THR and TKR. We searched MEDLINE (January 1997 to October 2009), EMBASE (January 1997 to June 2009) and the UK NHS Economic Evaluation Database (1997 to October 2009).

We analysed recent cost-effectiveness studies examining five categories of comparisons: (i) anticoagulants (warfarin, low-molecular-weight heparin [LMWH] or fondaparinux) versus acetylsalicylic acid (aspirin); (ii) LMWH versus warfarin; (iii) fondaparinux versus LMWH; (iv) comparisons with new oral anticoagulants; and (v) extended-duration (≥3 weeks) versus shortduration (<3 weeks) prophylaxis. We abstracted information on cost and effectiveness for each prophylaxis regimen in order to calculate an incremental cost-effectiveness ratio. Because of variations in effectiveness units reported and horizon length analysed, we calculated two cost-effectiveness ratios, one for the number of symptomatic VTE events avoided at 90 days and the other for QALYs at the 1-year mark or beyond.

Our search identified 33 studies with 67 comparisons. After standardization, comparisons between LMWH and warfarin were inconclusive, whereas fondaparinux dominated LMWH in nearly every comparison. The latter results were derived from radiographic VTE rates. Extended-duration prophylaxis after THR was generally cost effective. Small numbers prohibit conclusions about aspirin, new oral anticoagulants or extended-duration prophylaxis after TKR.

Fondaparinux after both THR and TKR and extended-duration LMWH after THR appear to be cost-effective prophylaxis regimens. Small numbers for other comparisons and absence of trials reporting symptomatic endpoints prohibit comprehensive conclusions.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Table I
Table II
Table III
Table IV
Table V
Table VI

Similar content being viewed by others

References

  1. Kapoor A, Labonte A, Winter M, et al. Venous thromboembolism after total hip and knee replacement in older adults with single and co-occurring comorbidities. Cleve Clin J Med 2010 Mar; 77 (Suppl. 1): eS8 [online]. Available from URL: http://www.ccjm.org/content/77/Electronic_Suppl_1/eS8.full.pdf+html [Accessed 2010 Mar 16]

    Google Scholar 

  2. Kurtz S, Ong K, Lau E, et al. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 2007 April 1; 89 (4): 780–5

    Article  PubMed  Google Scholar 

  3. Zhan C, Kaczmarek R, Loyo-Berrios N, et al. Incidence and short-term outcomes of primary and revision hip replacement in the United States. J Bone Joint Surg Am 2007 Mar; 89 (3): 526–33

    Article  PubMed  Google Scholar 

  4. Geerts WH, Pineo GF, Heit JA, et al. Prevention of venous thromboembolism: the Eighth ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 2008; 133 (3 Suppl.): 381S–453

    Article  PubMed  CAS  Google Scholar 

  5. American Academy of Orthopaedic Surgeons. American Academy of Orthopaedic Surgeons clinical guideline on prevention of pulmonary embolism in patients undergoing total hip or knee arthroplasty. Rosemont (IL): AAOS, 2007 May [online]. Available from URL: http://www.aaos.org/Research/guidelines/PE_guideline.pdf [Accessed 2007 Jul 10]

    Google Scholar 

  6. Bischof M, Leuppi JD, Sendi P. Cost-effectiveness of extended venous thromboembolism prophylaxis with fondaparinux in hip surgery patients. Exp Rev Pharmacoeconomics Outcomes Res 2006; 6 (2): 171–80

    Article  Google Scholar 

  7. Szucs TD, Kaiser WE, Mahler F, et al. Thromboembolic prophylaxis with fondaparinux in major orthopaedic surgery: outcomes and costs. Heartdrug 2005; 5 (3): 121–30

    Google Scholar 

  8. Bjorvatn A, Kristiansen F. Fondaparinux sodium compared with enoxaparin sodium: a cost-effectiveness analysis. Am J Cardiovasc Drugs 2005; 5 (2): 121–30

    Article  PubMed  CAS  Google Scholar 

  9. Skedgel C, Goeree R, Pleasance S, et al. The cost-effectiveness of extended-duration antithrombotic prophylaxis after total hip arthroplasty. J Bone Joint Surg Am 2007; 89 (4): 819–28

    Article  PubMed  Google Scholar 

  10. Alton V, Eckerlund I, Norlund A. Health economic evaluations: how to find them. Int J Technol Assess Health Care 2006; 22 (4): 512–7

    Article  PubMed  Google Scholar 

  11. National Institute for Health Research. Centre for Reviews and Dissemination. Economic evaluation database [online]. Available from URL: http://www.crd.york.ac.uk/crdweb/ [Accessed 2008 Nov 17]

  12. Russell LB, Gold MR, Siegel JE, et al. The role of costeffectiveness analysis in health and medicine. Panel on Cost-Effectiveness in Health and Medicine. JAMA 1996 Oct 9; 276 (14): 1172–7

    Article  PubMed  CAS  Google Scholar 

  13. Siegel JE, Weinstein MC, Russell LB, et al. Recommendations for reporting cost-effectiveness analyses. Panel on Cost-Effectiveness in Health and Medicine. JAMA 1996 Oct 23-30; 276 (16): 1339–41

    Article  PubMed  CAS  Google Scholar 

  14. Weinstein MC, Siegel JE, Gold MR, et al. Recommendations of the Panel on Cost-Effectiveness in Health and Medicine. JAMA 1996 Oct 16; 276 (15): 1253–8

    Article  PubMed  CAS  Google Scholar 

  15. Bank of Canada. Consumer price index 1995 to present. 2008 Jun 16 [online]. Available from URL: http://www.bankofcanada.ca/en/cpi.html [Accessed 2008 Jul 12]

    Google Scholar 

  16. European Commission. Harmonised indices of consumer prices. 2009 [online]. Available from URL: http://epp.eurostat.ec.europa.eu/portal/page/portal/hicp/data/main_tables [Accessed 2009 Nov 22]

    Google Scholar 

  17. WHO. Choosing Interventions that are Cost Effective (WHO-CHOICE) purchasing power parity 2005 [online]. Available from URL: http://www.who.int/choice/costs/ppp/en/index.html [Accessed 2009 Nov 22]

  18. US Department of Labor. Bureau of Labor Statistics. Consumer price index. 2008 [online]. Available from URL: http://www.bls.gov/cpi/ [Accessed 2008 Jun 13]

    Google Scholar 

  19. Bachmann MO. Cost effectiveness of community-based therapeutic care for children with severe acute malnutrition in Zambia: decision tree model. Cost Eff Resour Alloc 2009; 7 (1): 2

    Article  PubMed  Google Scholar 

  20. Drummond MF, O’Brien B, Stoddart G, et al. Methods for economic evaluation of health care programmes. Oxford: Oxford University Press, 1997

    Google Scholar 

  21. Brauer CA, Rosen AB, Olchanski NV, et al. Cost-utility analyses in orthopaedic surgery. J Bone Joint Surg Am 2005 Jun; 87 (6): 1253–9

    Article  PubMed  Google Scholar 

  22. Hunink M, Glasziou P, Siegel J. Decision making in health and medicine. 1st ed. Cambridge: Cambridge University Press, 2001

    Google Scholar 

  23. Bell CM, Urbach DR, Ray JG, et al. Bias in published cost effectiveness studies: systematic review. BMJ 2006; 332 (7543): 699–703

    Article  PubMed  Google Scholar 

  24. Abdool-Carrim T, Adler H, Becker P, et al. The cost and benefit of prophylaxis against deep vein thrombosis in elective hip replacement. DVT/PE Prophylaxis Consensus Forum. S Afr Med J 1997; 87 (5): 594–600

    PubMed  CAS  Google Scholar 

  25. Sarasin FP, Bounameaux H. Out of hospital antithrombotic prophylaxis after total hip replacement: low-molecularweight heparin, warfarin, aspirin or nothing? A cost-effectiveness analysis. Thromb Haemost 2002; 87 (4): 586–92

    PubMed  CAS  Google Scholar 

  26. Anderson DR, O’Brien B, Nagpal S. Economic evaluation comparing low molecular weight heparin with other modalities for the prevention of deep vein thrombosis and pulmonary embolism following total hip or knee arthroplasty. Ottawa (ON): Canadian Coordinating Office for Health Technology Assessment (CCOHTA), 1998

    Google Scholar 

  27. Bell GK, Goldhaber SZ. Cost implications of low molecular weight heparins as prophylaxis following total hip and knee replacement. Vasc Med 2001; 6 (1): 23–9

    PubMed  CAS  Google Scholar 

  28. Botteman MF, Caprini J, Stephens JM, et al. Results of an economic model to assess the cost-effectiveness of enoxaparin, a low-molecular-weight heparin, versus warfarin for the prophylaxis of deep vein thrombosis and associated long-term complications in total hip replacement surgery in the United States. Clin Therap 2002; 24 (11): 1960–86

    Article  CAS  Google Scholar 

  29. Caprini JA, Arcelus JI, Kudrna JC, et al. Cost-effectiveness of venous thromboembolism prophylaxis after total hip replacement. Phlebology 2002; 17 (3-4): 126–33

    Article  Google Scholar 

  30. Dahl OE, Pleil AM. Investment in prolonged thromboprophylaxis with dalteparin improves clinical outcomes after hip replacement. J Thromb Haemost 2003; 1 (5): 896–906

    Article  PubMed  CAS  Google Scholar 

  31. Francis CW, Pleil AM, Reinhart SP, et al. A pharmacoeconomic evaluation of low-molecular-weight heparin in patients after total hip-replacement surgery. P T 1999; 24 (3): 136–45

    Google Scholar 

  32. Friedman RJ, Dunsworth GA. Cost analyses of extended prophylaxis with enoxaparin after hip arthroplasty. Clin Orthop Relat Res 2000; 370: 171–82

    Article  PubMed  Google Scholar 

  33. Hawkins DW, Langley PC, Krueger KP. A pharmacoeconomic assessment of enoxaparin and warfarin as prophylaxis for deep vein thrombosis in patients undergoing knee replacement surgery. Clin Therap 1998; 20 (1): 182–95

    Article  CAS  Google Scholar 

  34. Hull RD, Raskob GE, Pineo GF, et al. Subcutaneous low-molecular-weight heparin vs warfarin for prophylaxis of deep vein thrombosis after hip or knee implantation: an economic perspective. Arch Int Med 1997; 157 (3): 298–303

    Article  CAS  Google Scholar 

  35. Nerurkar J, Wade WE, Martin BC. Cost/death averted with venous thromboembolism prophylaxis in patients undergoing total knee replacement or knee arthroplasty. Pharmacotherapy 2002; 22 (8): 990–1000

    Article  PubMed  Google Scholar 

  36. Wade WE, Hawkins DW. Cost effectiveness of outpatient anticoagulant prophylaxis after total hip arthroplasty. Orthopedics 2000; 23 (4): 335–8

    PubMed  CAS  Google Scholar 

  37. Wade WE, Spruill WJ. Cost analysis of the American College of Chest Physicians guidelines for deep vein thrombosis prophylaxis in patients undergoing orthopedic arthroplastic surgery. Pharmacotherapy 1997; 17 (6): 1286–91

    PubMed  CAS  Google Scholar 

  38. Gordois A, Posnett J, Borris L, et al. The cost-effectiveness of fondaparinux compared with enoxaparin as prophylaxis against thromboembolism following major orthopedic surgery. J Thromb Haemost 2003; 1 (10): 2167–74

    Article  PubMed  CAS  Google Scholar 

  39. Dranitsaris G, Kahn SR, Stumpo C, et al. Pharmacoeconomic analysis of fondaparinux versus enoxaparin for the prevention of thromboembolic events in orthopedic surgery patients. Am J Cardiovasc Drugs 2004; 4 (5): 325–33

    Article  PubMed  Google Scholar 

  40. Wade WE, Spruill WJ, Leslie RB. Cost analysis: fondaparinux versus preoperative and postoperative enoxaparin as venous thromboembolic event prophylaxis in elective hip arthroplasty. Am J Orthop 2003; 32 (4): 201–5

    PubMed  Google Scholar 

  41. Spruill WJ, Wade WE, Leslie RB. Cost analysis of fondaparinux versus enoxaparin as venous thromboembolism prophylaxis in elective hip replacement surgery. Blood Coagul Fibrinolysis 2004; 15 (7): 539–43

    PubMed  Google Scholar 

  42. Annemans L, Minjoulat-Rey MC, De Knock M, et al. Cost consequence analysis of fondaparinux versus enoxaparin in the prevention of venous thromboembolism after major orthopaedic surgery in Belgium. Acta Clinica Belgica 2004; 59 (6): 346–57

    PubMed  CAS  Google Scholar 

  43. Spruill WJ, Wade WE, Leslie RB. A cost analysis of fondaparinux versus enoxaparin in total knee arthroplasty. Am J Thera 2004; 11 (1): 3–8

    Article  Google Scholar 

  44. Lundkvist J, Bergqvist D, Jonsson B. Cost-effectiveness of fondaparinux vs enoxaparin as venous thromboembolism prophylaxis in Sweden. Eur J Health Econ 2003; 4 (4): 254–62

    Article  PubMed  Google Scholar 

  45. Sullivan SD, Davidson BL, Kahn SR, et al. A cost-effectiveness analysis of fondaparinux sodium compared with enoxaparin sodium as prophylaxis against venous thromboembolism: use in patients undergoing major orthopaedic surgery. Pharmacoeconomics 2004; 22 (9): 605–20

    Article  PubMed  CAS  Google Scholar 

  46. Bergqvist D. Cost-effectiveness of prolonged administration of a low molecular weight heparin for the prevention of deep venous thrombosis following total hip replacement. Value Health 1999; 2 (4): 288–94

    Article  PubMed  CAS  Google Scholar 

  47. Davies LM, Richardson GA, Cohen TA. Economic evaluation of enoxaparin as postdischarge prophylaxis for deep vein thrombosis (DVT) in elective hip surgery. Value Health 2000; 3 (6): 397–406

    Article  PubMed  CAS  Google Scholar 

  48. Detournay B, Planes A, Vochelle N, et al. Cost effectiveness of a low-molecular-weight heparin in prolonged prophylaxis against deep vein thrombosis after total hip replacement. Pharmacoeconomics 1998; 13 (1 Pt 1): 81–9

    Article  PubMed  CAS  Google Scholar 

  49. Haentjens P, De Groote K, Annemans L. Prolonged enoxaparin therapy to prevent venous thromboembolism after primary hip or knee replacement: a cost-utility analysis. Arch Orthop Trauma 2004; 124 (8): 507–17

    Article  Google Scholar 

  50. Dranitsaris G, Stumpo C, Smith R, et al. Extended dalteparin prophylaxis for venous thromboembolic events: costutility analysis in patients undergoing major orthopedic surgery. Am J Cardiovasc Drugs 2009; 9 (14): 45–8

    PubMed  Google Scholar 

  51. McCullagh L, Tilson L, Walsh C, et al. A cost-effectiveness model comparing rivaroxaban and dabigatran etexilate with enoxaparin sodium as thromboprophylaxis after total hip and total knee replacement in the Irish healthcare setting. Pharmacoeconomics 2009; 27 (10): 829–46

    Article  PubMed  Google Scholar 

  52. Wolowacz SE, Roskell NS, Maciver F, et al. Economic evaluation of dabigatran etexilate for the prevention of venous thromboembolism after total knee and hip replacement surgery. Clin Therap 2009; 31 (1): 194–212

    Article  Google Scholar 

  53. Sullivan SD, Kahn SR, Davidson BL, et al. Measuring the outcomes and pharmacoeconomic consequences of venous thromboembolism prophylaxis in major orthopaedic surgery. Pharmacoeconomics 2003; 21 (7): 477–96

    Article  PubMed  Google Scholar 

  54. Anderson Jr FA, Audet AM. Physician practices in the prevention of deep vein thrombosis: the Mass PRO DVT Study. Orthopedics 1996; 19: 9–11

    PubMed  Google Scholar 

  55. Anderson Jr FA, Hirsh J, White K, et al. Temporal trends in prevention of venous thromboembolism following primary total hip or knee arthroplasty 19962001: findings from the Hip and Knee Registry. Chest 2003 Dec; 124 (6 Suppl.): 349–56S

    Article  Google Scholar 

  56. Ivanovic N, Beinema M, Brouwers JR, et al. Thromboprophylaxis in total hip-replacement surgery in Europe: acenocoumarol, fondaparinux, dabigatran and rivaroxban. Exp Rev Pharmacoeconomics Outcomes Res 2007; 7 (1): 49–58

    Article  Google Scholar 

  57. Wolowacz SE, Hess N, Brennan VK, et al. Cost-effectiveness of venous thromboembolism prophylaxis in total hip and knee replacement surgery: the evolving application of health economic modelling over 20 years. Curr Med Res Opin 2008; 24 (10): 2993–3006

    Article  PubMed  CAS  Google Scholar 

  58. Bauer KA, Eriksson BI, Lassen MR, et al., Steering Committee of the Pentasaccharide in Major Knee Surgery Study. Fondaparinux compared with enoxaparin for the prevention of venous thromboembolism after elective major knee surgery. N Engl J Med 2001 Nov 1; 345 (18): 1305–10

    Article  PubMed  CAS  Google Scholar 

  59. Eriksson BI, Bauer KA, Lassen MR, et al., Steering Committee of the Pentasaccharide in Hip-Fracture Surgery Study. Fondaparinux compared with enoxaparin for the prevention of venous thromboembolism after hip fracture surgery. N Engl J Med 2001 Nov 1; 345 (18): 1298–304

    Article  PubMed  CAS  Google Scholar 

  60. Lassen MR, Bauer KA, Eriksson BI, et al., European Pentasaccharide Elective Surgery Study Steering Committee. Postoperative fondaparinux versus preoperative enoxaparin for prevention of venous thromboembolism in elective hip-replacement surgery: a randomised doubleblind comparison. Lancet 2002 May 18; 359 (9319): 1715–20

    Article  PubMed  CAS  Google Scholar 

  61. Turpie AG, Bauer KA, Eriksson BI, et al. Postoperative fondaparinux versus postoperative enoxaparin for prevention of venous thromboembolism after elective hipreplacement surgery: a randomised double-blind trial. Lancet 2002 May 18; 359 (9319): 1721–6

    Article  PubMed  CAS  Google Scholar 

  62. Turpie AG, Bauer KA, Eriksson BI, et al. Fondaparinux vs enoxaparin for the prevention of venous thromboembolism in major orthopedic surgery: a meta-analysis of 4 randomized double-blind studies. Arch Int Med 2002; 162 (16): 1833–40

    Article  CAS  Google Scholar 

  63. Quinlan DJ, Eikelboom JW, Dahl OE, et al. Association between asymptomatic deep vein thrombosis detected by venography and symptomatic venous thromboembolism in patients undergoing elective hip or knee surgery. J Thromb Haemost 2007; 5 (7): 1438–43

    Article  PubMed  CAS  Google Scholar 

  64. Bergqvist D, Benoni G, Bjorgell O, et al. Low-molecularweight heparin (enoxaparin) as prophylaxis against venous thromboembolism after total hip replacement. N Engl J Med 1996 Sep 5; 335 (10): 696–700

    Article  PubMed  CAS  Google Scholar 

  65. Comp PC, Spiro TE, Friedman RJ, et al. Prolonged enoxaparin therapy to prevent venous thromboembolism after primary hip or knee replacement. J Bone Joint Surg Am 2001 March 1; 83 (3): 336–45

    PubMed  Google Scholar 

  66. Dahl OE, Andreassen G, Aspelin T, et al. Prolonged thromboprophylaxis following hip replacement surgery: results of a double-blind, prospective, randomised, placebocontrolled study with dalteparin (Fragmin). Thromb Haemost 1997 Jan; 77 (1): 26–31

    PubMed  CAS  Google Scholar 

  67. Heit JA, Elliott CG, Trowbridge AA, et al. Ardeparin sodium for extended out-of-hospital prophylaxis against venous thromboembolism after total hip or knee replacement: a randomized, double-blind, placebo-controlled trial. Ann Intern Med 2000 Jun 6; 132 (11): 853–61

    PubMed  CAS  Google Scholar 

  68. Hull RD, Pineo GF, Francis C, et al. Low-molecular-weight heparin prophylaxis using dalteparin extended out-ofhospital vs in-hospital warfarin/out-of-hospital placebo in hip arthroplasty patients: a double-blind, randomized comparison. Arch Intern Med 2000 Jul 24; 160 (14): 2208–15

    Article  PubMed  CAS  Google Scholar 

  69. Planes A, Vochelle N, Darmon JY, et al. Risk of deepvenous thrombosis after hospital discharge in patients having undergone total hip replacement: double-blind randomised comparison of enoxaparin versus placebo. Lancet 1996 Jul 27; 348 (9022): 224–8

    Article  PubMed  CAS  Google Scholar 

  70. Prandoni P, Bruchi O, Sabbion P, et al. Prolonged thromboprophylaxis with oral anticoagulants after total hip arthroplasty: a prospective controlled randomized study. Arch Intern Med 2002 Sep 23; 162 (17): 1966–71

    Article  PubMed  CAS  Google Scholar 

  71. Drummond M, McGuire A, editors. Economic evaluation in health care: merging theory with practice. New York: Oxford University Press, 2001

    Google Scholar 

  72. Reinhardt U. Cost-effectiveness analysis and US health care. New York Times 2009 Mar 13 [online]. Available from URL: http://economix.blogs.nytimes.com/2009/03/13/cost-effectiveness-analysis-and-us-health-care/ [Accessed 2010 Mar 16]

    Google Scholar 

  73. Branson BM, Handsfield HH, Lampe MA, et al. Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. MMWR Recomm Rep 2006 Sep 22; 55 (RR-14): 1–17

    PubMed  Google Scholar 

  74. US Preventive Services Task Force. Screening for colorectal cancer: US Preventive Services Task Force recommendation statement. Ann Int Med 2008 Nov 4; 149 (9): 627–37

    Google Scholar 

Download references

Acknowledgements

The authors have no conflicts of interest that are directly relevant to the content of this review. This work was performed at Boston Medical Center affiliated with Boston University School of Medicine.

Author information

Authors and Affiliations

  1. Hospital Medicine Unit, Boston University School of Medicine, Boston, Massachusetts, 02118, USA

    Alok Kapoor & Nila Radhakrishnan

  2. Hospitalist Medicine Group, Massachusetts General Hospital, Boston, Massachusetts, USA

    Warren Chuang

  3. Section of Decision Sciences and Clinical Systems Modelling, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA

    Kenneth J. Smith

  4. Center for Health Quality, Outcomes, and Economic Research, Edith Nourse Rogers Memorial VA Hospital, Bedford, Massachusetts, USA

    Dan Berlowitz

  5. Boston University School of Medicine, Boston, Massachusetts, USA

    Dan Berlowitz

  6. Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA

    Jodi B. Segal

  7. Department of Orthopaedic Surgery and Division of Rheumatology, Immunology, and Allergy, and Orthopaedic and Arthritis Center for Outcomes Research, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA

    Jeffrey N. Katz

  8. Department of Orthopaedic Surgery, Brigham and Womens Hospital, Harvard Medical School, Boston, Massachusetts, USA

    Elena Losina

  9. Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA

    Elena Losina

Authors
  1. Alok Kapoor
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Warren Chuang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nila Radhakrishnan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kenneth J. Smith
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Dan Berlowitz
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jodi B. Segal
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jeffrey N. Katz
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Elena Losina
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Alok Kapoor.

Electronic supplementary material

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kapoor, A., Chuang, W., Radhakrishnan, N. et al. Cost Effectiveness of Venous Thromboembolism Pharmacological Prophylaxis in Total Hip and Knee Replacement. Pharmacoeconomics 28, 521–538 (2010). https://doi.org/10.2165/11535210-000000000-00000

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/11535210-000000000-00000

Keywords

Search

Navigation