ORIGINAL ARTICLE Health Economic Analysis of Thromboprophylaxis with Rivaroxaban and Certoparin-Sodium in Patients after Total Hip or Knee Replacement Karen Heidorn, Jennifer Haenschke, Tobias Lindner, Wolfram Mittelmeier, Ralf Skripitz Karen Heidorn, Jennifer Haenschke, Hospital pharmacy, Univer- sity Medicine Rostock, Rostock, Germany Tobias Lindner, Wolfram Mittelmeier, Ralf Skripitz, Department of Orthopaedics, University Medicine Rostock, Rostock, Germany Correspondence to: Tobias Lindner, Department of Orthopaedics, University Medicine Rostock, Rostock, Germany Email: tobias.lindner@med.uni-rostock.de Telephone:+49 381 494 9334 Received: April 3, 2014 Revised: May 19, 2014 Accepted: May 25, 2014 Published online: June 23, 2014 ABSTRACT AIM: Postoperative deep venous thrombosis is a common complication after major orthopedic surgery. Standard prophylaxis is done by repetitive subcutaneous injections of low molecular heparin. However new oral anticoagulants became available for these indication in the last years. The aim of this prospective, comparing clinical observational study was to develop a modeling matrix considering all costs in order to allow a cost-beneit-analysis comparing anticoagulants in the post-operative administration. MATERIALS AND METHODS: Ninety patients after total hip or knee replacement participated in this study. They were randomly divided in two groups (group - rivaroxaban, group - certoparin- sodium). Quality of life was measured by PACT-Q Score. Also compliance was analyzed by Morisky-Score. Clinical and laboratory data as well as information on occurrence and reason of readmittance to the hospital were collected. RESULTS: The price per treatment dose of rivaroxaban is nearly two times higher compared to certoparin-sodium. In a hospital setting, a relevant part of the difference is offset by the costs for preparing the subcutaneous application of certoparin-sodium. No significant differences in clinical outcomes could be observed, but the results of the PACT-Q and the Morisky questionnaire showed clear advantages of the rivaroxaban group concerning patient treatment satisfaction and compliance. CONCLUSION: The present study gives an idea of the consequence of the quality of life on the total costs. © 2014 ACT. All rights reserved. Key words: Venous thrombosis; Arthroplasty; Anticoagulants; Quality of life; Economic evaluation Heidorn K, Haenschke J, Lindner T, Mittelmeier W, Skripitz R. Health Economic Analysis of Thromboprophylaxis with Rivaroxaban and Certoparin-Sodium in Patients after Total Hip or Knee Replacement. International Journal of Orthopaedics 2014; 1(1): 15- 18 Available from: URL: http://www.ghrnet.org/index.php/ijo/article/ view/744 InTRoduCTIon The current standard for prophylaxis of venous thromboembolism (VTE) after knee or hip replacement operation is subcutaneous injection of low molecular heparin such as certoparin-sodium. Rivaroxaban was the first drug for oral application approved for VTE prophylaxis after total hip or knee replacement. The clinical eficacy and safety of rivaroxaban was demonstrated in randomised clinical trials and is comparable with other low molecular heparin [1] . An evaluation of the effectiveness in routine care includes associated aspects of application, as well as the subjectively perceived advantages and disadvantages for the patient. The incidence of symptomatic deep venous thrombosis in patients after hip or knee replacement without prophylactic anticoagulation lies between 40 and 60% [2] . There exists no clinically relevant difference between elective and fracture-conditioned interventions. In all patients after surgical interventions, injuries or acute illnesses the risk of venous thromboembolism should be considered. The indication for venous thromboembolism prophylaxis should be made risk-adapted and individually. The recommendations for the duration of prophylaxis are 28 to 35 days after a complete endoprosthesis of the hip joint and 11 to 14 days with a complete endoprosthesis of the knee joint [3] . Currently available anticoagulants are unfractionated heparin and low molecular heparin, as well as factor-X-a-inhibitors and thrombin-inhibitors. Heparin is administered subcutaneously, while factor-X-a-inhibitors are administered subcutaneously or orally. An apparent advantage of the oral medication seems to be the avoidance of the inconvenience of a subcutaneous injection. The 15 Int Journal of Orthopaedics 2014 June 23 1(1): 15-18 ISSN 2311-5106 Online Submissions: http://www.ghrnet.org/index./ijo/ doi:10.6051/j.issn.2311-5106.2014.01.1 © 2014 ACT. All rights reserved. International Journal of Orthopaedics