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Introduction: Prophylactic treatment reduces the risk of deep-vein thrombosis (DVT) and pulmonary embolism (PE) for major surgery in the lower limbs. Fondaparinux is a new synthetic antithrombotic pharmaceutical. The objective of this study was to analyse the cost-effectiveness of fondaparinux (synthetic factor X inhibitor) compared to that of enoxaparin (low-molecular-weight heparin) as prophylactic treatment for hip and knee surgery in Denmark. Materials and methods: The analysis was based on a decision model describing the costs and effects for a model population of 10,000 patients undergoing major surgery. Danish cost estimates in accordance with Danish clinical practice were used in the model. The age of the model population, the general mortality rate and the surgical procedure mix were extracted from Danish data. All the other parameters in the model were taken from international studies. Results: The base case result showed that fondaparinux was cost-saving for all three surgical procedures, i.e., hip fracture surgery, total hip replacement and total knee replacement. It saved approximately DKK 600 per patient undergoing major surgery. Fondaparinux was also more effective with respect to avoided DVT and PE, but it increased the risk of bleeding. A sensitivity analysis showed that the results were insensitive to changes in most of the parameters. Discussion: Decision model analyses showed that fondaparinux is cost-effective compared to enoxaparin and the cost savings are most distinct in relation to hip fracture patients. The validity of the relative risk reductions of DVT was crucial in creating the cost savings of fondaparinux.

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