Cost-effectiveness of edoxaban compared to warfarin for the treatment and secondary prevention of venous thromboembolism in the UK

Abstract

Background: Venous thromboembolism (VTE), which includes pulmonary embolism (PE) and deep vein thrombosis (DVT), is the third most common acute cardiovascular disease and represents an important burden for patients and payers.Objective: The aim was to estimate the cost-effectiveness of edoxaban, a non-VKA oral anticoagulant vs. warfarin, the currently most prescribed treatment for VTE in the UK.Study design: A Markov model was built using data from the Hokusai-VTE randomised controlled trial to estimate the lifetime costs and quality-adjusted life years (QALYs) in patients with VTE treated with edoxaban or warfarin over a lifetime horizon, from the UK National Health Services perspective. The model included VTE recurrences, VTE-related complications (post-thrombotic syndrome and chronic thromboembolic pulmonary hypertension), and several types of bleeds associated with anticoagulation treatment. Patients were treated during a period of 6 months after the first VTE event, followed by flexible treatment duration (from 6 months to lifetime) after recurrence, i.e., tertiary prevention.Results: Edoxaban was found dominant vs. warfarin with 0.033 additional QALY and £55 less costs. The reduction of patient management costs, specifically monitoring costs, outweighed the higher drug costs. Edoxaban was dominant in all subgroups (index DVT only, all PE cases (PE with or without DVT), PE without DVT and PE with DVT). Cost-savings ranged from £54 to £81 while additional QALYs ranged from 0.031 to 0.046. Edoxaban was found dominant in 88.6% of cases and cost-effective in additional 10.9% of cases considering a £20,000 threshold in the probabilistic sensitivity analysis.Conclusion: Edoxaban may improve patients’ quality of life in a lifetime horizon without additional costs for the healthcare system due to lower bleeding risk and no monitoring cost compared to warfarin.

A Real-World Cost-Effectiveness Analysis of Rivaroxaban versus Vitamin K Antagonists for the Treatment of Symptomatic Venous Thromboembolism: Lessons from the REMOTEV Registry

“…Although DOACs represent a valuable alternative compared to warfarin for the treatment of VTE patients, according to cost-effectiveness analyses using published clinical trials, new data were necessary in order to perform a real-world practice cost-effectiveness analysis, instead of using clinical trial data to feed the model [ 20 ]. To our knowledge, this study was the first analysis confirming the cost-effectiveness of rivaroxaban compared to VKAs for the treatment of VTE using real-world data.…”

“…Furthermore, in a cost-effectiveness analysis based on the HOKUSAI-VTE clinical trial data with a lifetime horizon, edoxaban was associated with 0.033 additional QALY and a low difference in costs of GBP 55 as compared to warfarin. Nonetheless, authors pointed out the necessity of using data coming from real-world studies rather than clinical trials because the balance between higher drug costs and the potential decrease of costs due to the reduction of VTE-related adverse events remains uncertain in current clinical practice [ 11 , 20 ].…”

Suppurative Thrombophlebitis of the Posterior Neck Caused by <i>Streptococcus constellatus</i>: A Case Report and Literature Review

“…However, the duration of treatment for suppurative thrombophlebitis is short with anticoagulants. In addition, considering increased bleeding events and blood sampling frequency for warfarin, 23) edoxaban may be more cost-eŠective than warfarin. However further study is needed on the types of anticoagulants that are most safe and eŠective for the treatment of suppurative thrombophlebitis.…”

The risk of venous thromboembolism associated with midline catheters compared with peripherally inserted central catheters: A systematic review and meta‐analysis

“…VTE is a potentially life-threatening condition that includes deep vein thrombosis (DVT) and pulmonary embolism (PE). The predominant symptoms of DVT include pain, tenderness and swelling of the involved limb, while those of PE include dyspnoea, tachypnoea and pleuritic chest pain (Clay et al,2018). VTE is a cause of significant economic burden in Europe (Cohen et al,2007).…”