Cost-effectiveness of Apixaban Versus Other Oral Anticoagulants for the Initial Treatment of Venous Thromboembolism and Prevention of Recurrence

Lanitis, Tereza; Leipold, Robert J.; Hamilton, Melissa; Rublee, Dale A.; Quon, Peter; Browne, Chantelle; Cohen, Alexander T.

doi:10.1016/j.clinthera.2016.01.020

Cited by 18 publications

(24 citation statements)

References 35 publications

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“…All of them suggested that DOACs are costeffective relative to VKA. 100,[104][105][106][107][108][109][110][111][112][113][114][115][116] Finally, we considered DOACs to be acceptable and feasible to implement in most scenarios. However, given their cost, some patients might not be able to afford them.…”

Section: Other Etd Criteria and Considerationsmentioning

confidence: 99%

American Society of Hematology 2020 Guidelines for Management of Venous Thromboembolism: Treatment of Deep Vein Thrombosis and Pulmonary Embolism

Ortel

Neumann

Ageno³

et al. 2020

Blood Advances

786

708

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Background: Venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE), occurs in ∼1 to 2 individuals per 1000 each year, corresponding to ∼300 000 to 600 000 events in the United States annually. Objective: These evidence-based guidelines from the American Society of Hematology (ASH) intend to support patients, clinicians, and others in decisions about treatment of VTE. Methods: ASH formed a multidisciplinary guideline panel balanced to minimize potential bias from conflicts of interest. The McMaster University GRADE Centre supported the guideline development process, including updating or performing systematic evidence reviews. The panel prioritized clinical questions and outcomes according to their importance for clinicians and adult patients. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess evidence and make recommendations, which were subject to public comment. Results: The panel agreed on 28 recommendations for the initial management of VTE, primary treatment, secondary prevention, and treatment of recurrent VTE events. Conclusions: Strong recommendations include the use of thrombolytic therapy for patients with PE and hemodynamic compromise, use of an international normalized ratio (INR) range of 2.0 to 3.0 over a lower INR range for patients with VTE who use a vitamin K antagonist (VKA) for secondary prevention, and use of indefinite anticoagulation for patients with recurrent unprovoked VTE. Conditional recommendations include the preference for home treatment over hospital-based treatment for uncomplicated DVT and PE at low risk for complications and a preference for direct oral anticoagulants over VKA for primary treatment of VTE.

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Section: Other Etd Criteria and Considerationsmentioning

confidence: 99%

American Society of Hematology 2020 Guidelines for Management of Venous Thromboembolism: Treatment of Deep Vein Thrombosis and Pulmonary Embolism

Ortel

Neumann

Ageno³

et al. 2020

Blood Advances

786

708

View full text Add to dashboard Cite

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“…28,30,31 Two studies reported results in terms of a number of events among a cohort of 10 000 patients. 27,32 One study reported fatality rates and one study reported relative risk (RR) of recurrent VTE. 26,29 Most articles conducted univariate (1-way) sensitivity analysis to determine the impact of every single parameter used in the analysis model on the total medical cost estimated through the model.…”

Section: Resultsmentioning

confidence: 99%

“…The majority of studies (n = 4) mostly used the cost/QALY measure, including the total costs calculations. 26,27,29,32 Jurgin et al reported that for 6-month therapy with dabigatran compared to 3-, 6-, and 12-month treatment with rivaroxaban for VTE treatment and extended anticoagulation and index DVT and PE treatment among a cohort of 10 000 patients, dabigatran is dominant over rivaroxaban, having lower cost and higher QALY, in all these settings. A similar trend was observed in their study evaluating the VTE treatment and extended anticoagulation indication, and for index DVT and PE treatment in 6-month therapy among a cohort of 10 000 patients for both dabigatran and rivaroxaban, where dabigatran also dominates rivaroxaban in all these settings.…”

Section: Resultsmentioning

confidence: 99%

“…All studies in this review included dabigatran and rivaroxaban as part of the DOACs compared. [26][27][28][29][30][31][32] Apixaban was included in 6 studies and edoxaban was included in 2 studies only. Furthermore, because of how recently approved it is, betrixaban was not included in any of the studies.…”

Section: Characteristics Of the Included Articlesmentioning

confidence: 99%

“…Other events were chronic thromboembolic pulmonary hypertension, post thromboembolic syndrome, and intracranial bleed. These clinical events were evaluated over patient lifetime, 26,27,29,32 except for Amin et al where the events were evaluated on annual basis. 28,30,31 Among the 7 included studies, 3 were conducted in the United States, 28,30,31 2 in the United Kingdom, 26,32 and 2 in Canada.…”

Section: Characteristics Of the Included Articlesmentioning

confidence: 99%

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Cost-effectiveness Evaluations Among the Direct Oral Anticoagulants for the Prevention and Treatment of Venous Thromboembolism: Systematic Review

Mukdad

Al‐Badriyeh

Elewa

2019

Clin Appl Thromb Hemost

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Venous thromboembolism (VTE) is associated with high recurrence, mortality, and cost burden. Direct oral anticoagulants (DOACs) are currently used for VTE treatment, and they offer more benefits over warfarin, despite being more expensive. There is no consensus on the most cost-effective DOAC agent, especially in VTE. This systematic review aims to summarize the comparative cost-effectiveness studies and their impact among DOACs in the treatment of VTE. Literature systematic review of PubMed, Embase, and EconLit was conducted in February 2018 to identify all cost-effectiveness studies of DOAC for the treatment and prevention of VTE. Two independent investigators systematically collected search results and assessed the quality of the studies. The search identified 7 articles, all of which had dabigatran and rivaroxaban as comparators, 6 of which also included apixaban, and 2 of which also had edoxaban. Results of 3 articles concluded that apixaban is a dominant strategy compared to other DOACs in terms of Incremental Cost-Effectiveness Ratio (ICER) in the treatment and prevention of recurrent VTE. One article compared rivaroxaban and dabigatran, with the latter dominating rivaroxaban in terms of ICER. Compared to other DOACs, 2 articles reported apixaban being associated with highest annual total medical cost avoidance of US$4244 and US$4440 per patient-year (ppy), respectively. One article reported that apixaban had the highest annual total medical cost differences of US$918 ppy compared to other DOACs. This systematic review demonstrates that apixaban is considered a cost-effective strategy for VTE treatment and prevention of recurrent VTE.

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Comparative Analysis of All-Cause Health Care Resource Utilization and Costs Among Venous Thrombosis Patients Without Cancer Prescribed Apixaban or VKAs in France

Mokgokong

Khachatryan²,

Quignot³

et al. 2022

Adv Ther

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Introduction:The direct oral anticoagulant (DOAC) apixaban has shown to have non-inferior efficacy and better safety than vitamin K antagonists (VKAs) in patients with venous thromboembolism (VTE). We determined whether healthcare resource use (HCRU) and direct all-cause medical and non-medical costs in patients with VTE in France differed between VKAs and apixaban. Methods: A retrospective cohort study was conducted using French national health data from January 2013-June 2018 for anticoagulant-naı ¨ve adults hospitalized with VTE. All-cause costs and HCRU per patient per month (PPPM) were compared between apixaban and VKA cohorts created by 1:1 propensity score matching. Two-part models with bootstrapping were used to calculate marginal effects for costs and HCRU.Results: The matched VKA and apixaban cohorts each comprised 7503 patients. Compared to VKAs, patients prescribed apixaban had significantly lower (P \ 0.0001) mean all-cause costs PPPM for outpatient visits (€438.54 vs. €455.58), overall laboratory tests (€21.26 vs. €83.73), and hospitalizations (€249.48 vs. €343.82), but significantly higher (P \ 0.0001) mean all-cause costs PPPM for overall drugs (€97.06 vs. €69.56) and medical procedures (€42.12 vs. €35.50). Mean total all-cause direct medical costs (€687.93 vs. €798.70) and total all-cause direct medical and non-medical costs (€771.60 vs. €883.66) were significantly lower (P \ 0.0001) for apixaban. Mean HCRU PPPM showed similar trends. Subgroup analyses showed that, among patients with recurrent VTE, patients prescribed apixaban had significantly lower (P \ 0.0001) all-cause costs PPPM for total medical costs (€17.26 vs. €18.12) and total all-cause direct medical and non-medical costs (€18.37 vs. €19.20) than patients prescribed VKAs. Similarly, among patients with bleeding, patients prescribed apixaban had significantly lower (P \ 0.0001) all-cause costs PPPM for total medical costs (€15.34 vs. €32.61

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Cost-effectiveness of Apixaban Versus Other Oral Anticoagulants for the Initial Treatment of Venous Thromboembolism and Prevention of Recurrence

Cited by 18 publications

References 35 publications

American Society of Hematology 2020 Guidelines for Management of Venous Thromboembolism: Treatment of Deep Vein Thrombosis and Pulmonary Embolism

American Society of Hematology 2020 Guidelines for Management of Venous Thromboembolism: Treatment of Deep Vein Thrombosis and Pulmonary Embolism

Cost-effectiveness Evaluations Among the Direct Oral Anticoagulants for the Prevention and Treatment of Venous Thromboembolism: Systematic Review

Comparative Analysis of All-Cause Health Care Resource Utilization and Costs Among Venous Thrombosis Patients Without Cancer Prescribed Apixaban or VKAs in France

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