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Incidence of complications of TKA<\/jats:styled-content> and anticoagulation therapy (deep vein thrombosis [DVT<\/jats:styled-content>], pulmonary embolism [PE<\/jats:styled-content>], prosthetic joint infection [PJI<\/jats:styled-content>], and bleeding) were derived from published literature. Daily costs ranged from $1 (aspirin) to $43 (fondaparinux). Primary outcomes included quality\u2010adjusted life years (QALY<\/jats:styled-content>s), direct medical costs, and incremental cost\u2010effectiveness ratios (ICER<\/jats:styled-content>s) at 1 year post\u2010TKA<\/jats:styled-content>. The preferred regimen was the regimen with highest QALY<\/jats:styled-content>s maintaining an ICER<\/jats:styled-content> below the willingness\u2010to\u2010pay threshold ($100,000\/QALY<\/jats:styled-content>). We conducted probabilistic sensitivity analyses, varying complication incidence and anticoagulation efficacy, to evaluate the impact of parameter uncertainty on model results.<\/jats:p><\/jats:sec>Results<\/jats:title>Aspirin resulted in the highest cumulative incidence of DVT<\/jats:styled-content> and PE<\/jats:styled-content>, while prolonged fondaparinux led to the largest reduction in DVT<\/jats:styled-content> incidence (15% reduction compared to no prophylaxis). Despite differential bleeding rates (ranging from 3% to 6%), all strategies had similar incidence of PJI<\/jats:styled-content> (1% to 2%). Prolonged rivaroxaban was the least costly strategy ($3,300 at 1 year post\u2010TKA<\/jats:styled-content>) and the preferred regimen in the base case. In sensitivity analyses, prolonged rivaroxaban and warfarin had similar likelihoods of being cost\u2010effective.<\/jats:p><\/jats:sec>Conclusion<\/jats:title>Extending postoperative anticoagulation therapy to 35 days increases QALY<\/jats:styled-content>s compared to standard 14\u2010day prophylaxis. Prolonged rivaroxaban and prolonged warfarin are most likely to be cost\u2010effective post\u2010TKA<\/jats:styled-content>; the costs of fondaparinux and LMWH<\/jats:styled-content> precluded their being preferred strategies.<\/jats:p><\/jats:sec>","DOI":"10.1002\/acr.23803","type":"journal-article","created":{"date-parts":[[2018,10,28]],"date-time":"2018-10-28T09:40:42Z","timestamp":1540719642000},"page":"1621-1629","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Cost\u2010Effectiveness of Alternative Anticoagulation Strategies for Postoperative Management of Total Knee Arthroplasty Patients"],"prefix":"10.1002","volume":"71","author":[{"given":"Savannah R.","family":"Smith","sequence":"first","affiliation":[{"name":"George Washington University School of Medicine and Health Sciences, Washington, DC, and Brigham and Women's Hospital Boston Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeffrey N.","family":"Katz","sequence":"additional","affiliation":[{"name":"Brigham and Women's Hospital and Harvard Medical School Boston Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8229-6674","authenticated-orcid":false,"given":"Elena","family":"Losina","sequence":"additional","affiliation":[{"name":"Brigham and Women's Hospital Harvard Medical School, and Boston University School of Public Health Boston Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2019,11,5]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"crossref","first-page":"I9","DOI":"10.1161\/01.CIR.0000078469.07362.E6","article-title":"Risk factors for venous thromboembolism","volume":"107","author":"Anderson FA","year":"2003","journal-title":"Circulation"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1054\/arth.2001.21499"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-198466020-00005"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(98)07534-5"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amepre.2009.12.017"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.109.925214"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.11-2404"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.5435\/00124635-201112000-00007"},{"key":"e_1_2_6_10_1","unstructured":"Centers for Medicare and Medicaid Services.Physician fee schedule. 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