Economic Analysis Comparing Dalteparin to Vitamin K Antagonists to Prevent Recurrent Venous Thromboembolism in Patients With Cancer Having Renal Impairment

Abstract

Secondary prophylaxis with dalteparin is a cost-effective alternative to VKA for the prevention of recurrent VTE in patients with cancer.

Patient values and preferences regarding VTE disease: a systematic review to inform American Society of Hematology guidelines

“…Two studies in cancer patients receiving LMWH treatment also showed lower RIOs for attributes such as monitoring through blood tests, frequency of administration, mistakes, and costs (509 participants from 2 studies; moderate certainty) 46,54 ( Table 4). One study evaluating elastic compression stockings showed that participants would accept an increase in the risk of complications if they could put them on by themselves (300 participants from 1 study; moderate certainty) 43 ( Table 4, 25 Keita et al, 29 Locadia et al, 32 Marchetti et al 33 High certainty in evidence: We are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: We are moderately confident in the effect estimate; the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different.…”

“…83 Overall, we included 44 quantitative studies, [55][56][57][58][59][60][61][62][63][64][65][80][81][82] 14 qualitative studies, [66][67][68][69][70][71][72][73][74][75][76][77][78][79] and 1 study with both types of evidence 54 (Figure 1). Fourteen of the included studies reported patients' values or utilities, [24][25][26][27][28][29][30][31][32][33][34][35][36][37] 34 nonutility studies used quantitative methods, 24,32,35,[80][81]…”

“…We identified 14 studies, [24][25][26][27][28][29][30][31][32][33][34][35][36][37] including 2465 participants, reporting utility or health state values of DVT, pulmonary embolism (PE), postthrombotic syndrome (PTS) (mild and severe), and bleeding events, as well as utilities of using treatments such as vitamin K antagonists (VKAs) and low molecular weight heparin (LMWH) ( Figure 2; Tables 1 and 2).…”

“…Utility values ranged from 0.38 to 0.99 for VKA treatment (296 participants from 4 studies). 25,29,32,33 For LMWH treatment, a range of 0.66 to 0.99 was reported in the general population (72 participants from 2 studies) 25,33 and 83 (IQR, 70-90) was reported in pregnant women (123 participants from 1 study). 24 Overall, results showed considerable variability, and certainty was judged as moderate or low.…”

Low-molecular-weight heparins for the prevention of recurrent venous thromboembolism in patients with cancer: A systematic literature review of efficacy and cost-effectiveness

“…However, five cost-effectiveness analyses were identified for dalteparin. 7,26–28 All the economic analyses were patient-level cost-effectiveness and cost-utility studies using resource-use data that was collected during the CLOT randomized trial.…”