Objective  To evaluate the cost-effectiveness of fondaparinux compared with low molecular-weight heparin in the treatment of recurrent spontaneous abortion (RSA), to provide a basis for rational clinical medication.

Methods  A decision tree model was developed from the perspective of the healthcare system, probability parameters were derived from published literature and cost parameters were from Gansu provincial centralized drug procurement platform and medical insurance payment standards. Furthermore, cost-effectiveness analysis was conducted on two treatment options, one-way sensitivity analysis and probabilistic sensitivity analysis were performed to verify the robustness of the results.

Results  The results of cost-effectiveness analysis showed that compared with low molecular-weight heparin, the incremental effect of fondaparinux was 0.12, the incremental cost was 501.17 yuan, and the incremental cost-effectiveness ratio was 4,176.42 yuan per effective case. Using the per capita disposable income of Gansu Province residents in 2024 (26,612 yuan) as the willingness-to-pay (WTP) threshold, the probability that fondaparinux had a cost-effectiveness advantage was 100%. The sensitivity analysis results were consistent with those of the cost-effectiveness analysis.

Conclusion  Fondaparinux has an economic advantage over low molecular-weight heparin in the anticoagulant treatment of patients with recurrent spontaneous abortion. Clinical medication can be selected according to the patient's WTP.

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