Cost-effectiveness of apixaban for prevention of venous thromboembolic events in patients after gynecologic cancer surgery

Apixaban vs Enoxaparin for Post-Surgical Extended-Duration Venous Thromboembolic Event Prophylaxis: A Prospective Quality Improvement Study

“…While cost-effectiveness is beyond the scope of this manuscript, studies have shown that apixaban may be more cost effective than enoxaparin for EP as well as hospitalized inpatients due to lower rates VTEs. 29,30 Currently DOACs do not have U.S. Food and Drug Administration approval for postsurgical EP prophylaxis, and apixaban is not expected to be available as a generic medication until April 2028. However, generic enoxaparin can also be expensive.…”

Provider education program on the Khorana score to promote venous thromboembolism chemoprophylaxis in patients with gynecologic cancer

“…All barriers to initiation of chemoprophylaxis were not captured completely in this study and may be a target of future research, but cost was identified as a barrier for one patient. While direct oral anticoagulants are notably more expensive than other prophylactic agents, including vitamin K antagonists and low molecular weight heparin, apixaban has been shown to be more cost effective for deep venous thrombosis prophylaxis than enoxaparin in the post-operative gynecologic surgical setting 18. Because most venous thromboembolism in patients with gynecologic cancer occurs outside the post-operative setting, further research is required to determine if direct oral anticoagulants are similarly cost effective beyond the post-operative period 19…”

Use of direct oral anticoagulants for postoperative venous thromboembolism prophylaxis after surgery for gynecologic malignancies

“…32 A cost effective analysis by Glickman et al compared 28 days of apixaban with enoxaparin in the prevention of venous thromboembolism following gynecologic oncology surgery. 33 The authors found that overall, apixaban had a lower aggregated net cost compared with enoxaparin (apixaban USD$175 967 vs enoxaparin USD$202,981). 33 By disaggregated results, apixaban was superior in cost effectiveness in the prevention of deep vein thrombosis events (net savings of $258,995) but not cost effective in the prevention of pulmonary embolism.…”

“…33 The authors found that overall, apixaban had a lower aggregated net cost compared with enoxaparin (apixaban USD$175 967 vs enoxaparin USD$202,981). 33 By disaggregated results, apixaban was superior in cost effectiveness in the prevention of deep vein thrombosis events (net savings of $258,995) but not cost effective in the prevention of pulmonary embolism. This might be due to lower reported deep vein thrombosis rates compared with pulmonary embolism rates although individual venous thromboembolism outcomes are difficult to analyze as clinical trials would often report composite venous thromboembolism outcomes.…”

“…Interestingly, the Review event cost per patient which incorporates inpatient, outpatient, and pharmaceutical was estimated at USD$20 397 for deep vein thrombosis and USD$22 144 for pulmonary embolism. 33 The authors also concluded that these data could be extrapolated to patients undergoing surgery for non-gynecologic cancers.…”