Surgical Thromboprophylaxis in Patients With Head and Neck Cancer: An Economic Model

Abstract

Abstract Objective To quantify postoperative venous thromboembolism (VTE) incidence in head and neck cancer (HNC) patients, and assess the economic implications of chemoprophylaxis. Study Design Retrospective cost‐effective analysis. Setting Fifty‐three health care organizations. Methods The TriNetX Research Network was queried to identify the 1‐month VTE rate in HNC patients undergoing neck dissection from 2012 to 2022. A literature search provided additional postsurgical VTE rates in HNC patients. Costs of prophylactic heparin and enoxaparin were obtained from a drug wholesaler, and VTE‐associated medical costs were sourced from the literature. A break‐even analysis determined the absolute risk reduction (ARR) in the VTE rate necessary for a medication to break‐even on cost. Results In TriNetX, 8193 HNC surgical patients underwent neck dissection, and an additional 1640 patients underwent neck dissection plus free flap reconstruction without chemoprophylaxis. Respective 1‐month VTE rates were 1.3% (n = 103) and 2.5% (n = 41). Four additional studies of 1546 postoperative HNC patients not prescribed chemoprophylaxis reported a mean VTE rate of 3.8% (n = 59), ranging from 1.9% to 13.0%. At $8.40 per week, heparin resulted in cost savings if it decreased the VTE rate by an ARR of at least 0.05%, while enoxaparin, at $23.66 per week, needed to achieve a 0.14% ARR. Considering potential added costs from bleeding complications, heparin, and enoxaparin remained cost‐effective if chemoprophylaxis did not increase bleeding complications by an absolute risk of more than 2.86% and 2.79%, respectively. Conclusion Postoperative VTE rates varied in HNC patients. Despite this, achievable ARRs suggested the potential cost‐effectiveness of routine chemoprophylaxis with heparin and enoxaparin.

Keywords

• chemoprophylaxis
• cost‐effective
• deep venous thrombosis
• head and neck cancer
• pulmonary embolism
• VTE