Macedonian pharmaceutical bulletin, 64 (1) 79 - 88 (2018) ISSN: UDC: 615.273.53.035.4:[616-089.168.1:616.14-005.6/.7 DOI: 10.33320/maced.pharm.bull.2018.64.01.007 Original scientific paper Cost-effectiveness of LMWHs versus UFH for the prevention of postsurgical venous thromboembolism at orthopedic department in Clinical Hospital Stip Biljana Lazarova 1* , Aleksandra Kapedanovska Nestorovska 2 , Zoran Sterjev 2 , Ljubica Suturkova 2 1 Clinical Hospital, Ljuben Ivanov bb, 2000 Stip, R. Macedonia 2 Faculty of Pharmacy, Ss. Cyril and Methodius University, Majka Tereza 47, 1000 Skopje, R. Macedonia Received: September 2018; Accepted: November 2018 Abstract This study aimed to evaluate the cost-effectiveness of thromboprophylaxis with LMWHs vs UFH in the prevention of venous thromboembolism (VTE) after orthopedic surgery from the perspective of the Clinical hospital in Stip. A model was developed that included both acute VTE (represented as a decision tree) and long-term complications (represented as a Markov process with one-year cycles). Transition probabilities were derived from phase III clinical trials comparing LMWHs with UFH and published literature. Unit costs were taken from the official, publically available hospital and health care insurance data and included direct drug costs for VTE (DVT and PE) prophylaxis (UFH/10000 IU and LMWHs/4000 IU) and hospitalization costs (hospital full board, disposables, medical services, concomitant therapy, healthcare professional time). Costs are reported in Macedonian Denars (MKD). When LMWHs and UFH are compared in orthopedic patients, LMWHs dominates UFH and are associated with improved health outcomes, measured by increased quality-adjusted life years (QALYs; 0.05) and with lower cost (savings of 20438.96 MKD) per patient. LMWHs are a cost-saving alternative to UFH for VTE prophylaxis in patients undergoing orthopedic surgery. Over a one-year horizon, LMWHs dominated UFH in the prevention of VTE events in patients undergoing surgery, providing more quality-of-life benefit at a lower cost. Keywords: anticoagulants, surgery, thrombosis Introduction Venous thromboembolism (VTE), which includes both deep vein thrombosis (DVT) and pulmonary embolism (PE), is a major burden on the health care system that caused surgeons to send an action call as early as 2008 (Anderson et al., 2007; Galson et al., 2008). The Health Care and Quality Research Agency stated that the provision of thromboprophylaxis is one of the most important steps to improve patient safety (Galson et al., 2008). Thromboprophylaxis significantly reduces the risk of perioperative VTE. The longer duration of thromboprophylaxis, the lower incidence of VTE. Without anticoagulant prophylaxis, about 50% of patients with symptomatic proximal DVT or PE have a recurrent thrombosis within three months (Torbicki et al., 2008). The risk of VTE is particularly high in patients who undergo major orthopedic surgical interventions, especially interventions for total hip or knee replacement __________________ * blazarova55@yahoo.com