OBJECTIVES: Venous Thromboembolism (VTE) is one of the most frequent complications after orthopedic surgery and significantly contributes to perioperative mortality in orthopedic patients. The systematic review aimed to investigate the economic evidence for different pharmacological interventions to prevent VTE in patients undergoing hip or knee arthroplasty.

METHODS: Studies published in English were searched in PubMed, Web of Science and Embase up to September 1, 2023. The eligible criteria included 1) health economic evaluation (HEE) studies, including cost effectiveness analysis (CEA), cost utility analysis (CUA), cost benefit analysis, et.al; 2) compared different pharmacological interventions to prevent VTE; 3) in patient undergoing hip or knee arthroplasty. Two reviewers screened the search results independently, with disagreement resolved by discussion. Study population, type of health economic evaluation, evaluating prospective, pharmacological interventions, type of economic model and study results were extracted for each HEE study.

RESULTS: Within 37 included HEE studies, 24 studies had CEA and 19 studies had CUA. About 94.5% HEE studies were conducted from healthcare system perspective (n=19) or payer perspective (n=16) and 34 HEE studies used decision analysis model (n=18) or Markov model (n=16) in statistical analysis. In 24 CEA studies, from healthcare system perspective or payer perspective, rivaroxaban (n=8), fondaparinux sodium (n=5), dabigatran (n=4) might be more cost-effective than enoxaparin to prevent VTE in patients underwent hip or knee arthroplasty. In 19 CUA studies, from healthcare system perspective or payer perspective, rivaroxaban (n=7) and dabigatran (n=5) might have greater cost-utility than enoxaparin in preventing VTE in patients undergoing hip or knee arthroplasty.

CONCLUSIONS: From healthcare system perspective or payer perspective, rivaroxaban, fondaparinux sodium or dabigatran might gain more effectiveness or utility to prevent VTE in patients undergoing hip or knee arthroplasty. More HEE studies are needed for other pharmacological interventions and economic evaluating perspectives.