Healthcare resource utilization and costs associated with venous thromboembolism in cancer patients treated with anticoagulants

Streiff, Michael B.; Milentijevic, Dejan; McCrae, Keith R.; Laliberté, François; Lejeune, Dominique; Lefèbvre, Patrick; Schein, Jeff; Khorana, Alok A.

doi:10.1080/13696998.2019.1620752

Cited by 13 publications

(12 citation statements)

References 26 publications

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“…This is line with findings from a recent study that assessed the VTE-related healthcare costs in patients with cancer, which found that rivaroxaban-treated patients had a significantly lower total VTE-related costs relative to patients treated with LMWH. 33 Although the cost difference between the rivaroxaban and dalteparin cohorts was even greater with $12 004 per patient per year.…”

Section: Discussionmentioning

confidence: 99%

Cost-effectiveness analysis and budget impact of rivaroxaban compared with dalteparin in patients with cancer at risk of recurrent venous thromboembolism

et al. 2020

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ObjectivesIn the ‘Comparison of an Oral Factor Xa Inhibitor With Low Molecular Weight Heparin in Patients With Cancer With Venous Thromboembolism’ (SELECT-D) trial, rivaroxaban showed relatively low venous thromboembolism (VTE) recurrence but higher bleeding compared with dalteparin in patients with cancer. We aim to calculate the cost-effectiveness and budget impact of rivaroxaban compared with dalteparin in patients with cancer at risk of recurrent VTE.SettingWe built a Markov model to calculate the cost-effectiveness from a societal perspective over a 5-year time horizon for the Dutch healthcare setting.ParticipantsA hypothetical cohort of 1000 cancer patients with VTE entered the model with baseline characteristics based on the SELECT-D trial.InterventionSix months of treatment with rivaroxaban (15 mg two times per day for first 3 weeks followed by 20 mg once daily) was compared with 6 months of treatment with dalteparin (200 IU/kg daily during month 1 followed by 150 IU/kg daily).Primary and secondary outcome measuresThe primary outcome of the cost-effectiveness analysis was the incremental cost-effectiveness ratio (ICER). The robustness of the model was evaluated in probabilistic and univariate sensitivity analyses. A budget impact analysis was performed to calculate the total annual financial consequences for a societal perspective in the Netherlands.ResultsIn the base case and all scenarios, rivaroxaban were cost-saving while also slightly improving the patient’s health, resulting in economically dominant ICERs. In the probabilistic sensitivity analysis, 77.8% and 98.7% of the simulations showed rivaroxaban to be cost-saving and more effective for a 5-year and 6-month time horizon, respectively. Rivaroxaban can save up to €11 326 763 (CI €5 164 254 to €17 363 231) in approximately 8000 cancer patients with VTE per year compared with dalteparin based on a 1-year time horizon.ConclusionsTreatment with rivaroxaban is economically dominant over dalteparin in patients with cancer at risk for recurrent VTE in the Netherlands. The use of rivaroxaban instead of dalteparin can save over €10 million per year, primarily driven by the difference in drug costs.

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Section: Discussionmentioning

confidence: 99%

Cost-effectiveness analysis and budget impact of rivaroxaban compared with dalteparin in patients with cancer at risk of recurrent venous thromboembolism

et al. 2020

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“…The patients may be suffering from pancreatic cancer, breast cancer, genitourinary cancer, lung cancer, ovarian cancer, gastroesophageal cancer squamous cell carcinoma, adenocarcinoma, and lymphoma [28,[32][33]. In ambulatory patients, rivaroxiban showed a decreased risk of VTE but major bleeding occurred in few cases and in some cases, the reoccurrence of VTE and bleeding increased [23,33]. In primary and metastatic brain cancer, this drug showed more safety than LMWH [34].…”

Section: Use Of Noacs In Different Cancersmentioning

confidence: 99%

Use of New Oral Anticoagulants/ Direct Oral Anticoagulants in Malignant Patients

Khan¹,

Zaidi²,

Razak³

et al. 2020

Cureus

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Vitamin K antagonists are being used in the last five decades as an effective anticoagulant. However, for the past few years, new oral anticoagulants (NOACs) have been introduced as newer anticoagulant agents, which are gradually replacing the previously used vitamin K antagonist. Yet, these agents have not fully replaced the use of warfarin and heparin. NOACs have few advantages over the vitamin K antagonist as they act on a specific factor of coagulation cascade rather than inhibiting the whole vitamin K synthesis. In this article, all the data has been searched electronically on PubMed and PRISMA guidelines were not followed. Instead, we used MOOSE statements and the data searched on PubMed was from articles published in the last five years. A total of 12,269 patients were observed;,out of which 64.19% had active cancer and 35.80% was observed as a control group comprised of both male or female participants. Approximately 61.14% were using NOACs, 42.83% were on warfarin, and 2.72% were on low-molecular-weight heparin (LMWH). The NOACs used in different patients were in the following percentages; edoxaban (6.81%), apixaban (5.28%), dabigatran (10.09%), and rivaroxaban (10.02%). The use of NOACs has been increasing day by day but these agents have not completely replaced the warfarin or heparin, because of some demerits associated with the use of warfarin and some conditions where these drugs should be avoided. All NOACs have either hepatic or renal clearance so the hepatic activity and creatinine clearance rate must be monitored before the start of NOACs. The drug interaction between anticancer drugs and NOACs is still not fully reported. The effects of NOACs in AF and VTE are therapeutically effective, but in oncology patients several other co-factors are also involved with the use of NOACs due to which, it is either contraindicated or in some cases dose adjustment is required. However, very little information has been collected and more investigation must be done in this perspective. Categories: Cardiology, Oncology, Hematology Keywords: new oral anti-coagulants, atrial fibrillation in cancer patients, venousthromboembolisim in cancer patients, cancer assossiated thrombosis, rivaroxiban in cancer patients, apixaban in cancer patients, edoxaban in cancer patients, dabigatrin in cancer patients Open Access Review Article

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“…Randomized controlled trials (RCTs) had demonstrated superior efficacy to vitamin K antagonists in preventing recurrent VTE with similar rates of major bleeding 8,9 . However, long term adherence with subcutaneous LMWH is highly variable, ranging between 19 to 70% 10 , and can be associated with higher healthcare costs compared to other anticoagulants 11 .…”

Section: Introductionmentioning

confidence: 99%

Direct oral anticoagulants for cancer‐associated venous thromboembolisms: a systematic review and network meta‐analysis

Samaranayake

Anderson

McCabe

et al. 2022

Internal Medicine Journal

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Background: Several recent randomised controlled trials (RCT) have investigated the use of direct oral anticoagulants (DOAC) in the treatment of malignancy-associated venous thromboembolism (VTE).Aims: This meta-analysis combines all RCT data to determine the risks of recurrent VTE and bleeding with DOAC in patients with malignancy-associated VTE compared with low-molecular-weight heparin (LMWH). Methods:The study followed PRISMA guidelines. MEDLINE, EMBASE and CENTRAL were systematically searched from inception to 1 April 2020. References of reviews and relevant conference proceedings were searched by hand. Two authors independently evaluated study eligibility, extracted data and assessed risk of bias. Direct and indirect meta-analyses were performed.Results: In four RCT with low risk of bias (2907 patients), high certainty evidence suggested that DOAC had a 37% reduction in risk of recurrent VTE compared with LMWH (direct pooled risk ratio (RR) 0.63; 95% confidence interval (CI) 0.44-0.91; I 2 = 28%). No significant difference was observed in the risk of major bleeding with DOAC compared with LMWH (RR 1.31; 95% CI 0.83-2.07; I 2 = 22%; moderate certainty evidence), including in patients in gastrointestinal and genitourinary malignancy. An increased risk of combined major or clinically relevant non-major bleeding was seen with DOAC (RR 1.52; 95% CI 1.09-2.12; I 2 = 51%; low certainty evidence). Apixaban had the highest probability of being ranked the most effective and least bleeding risk among the DOAC.Conclusion: DOAC are effective in treating malignancy associated VTE; however, caution is required in patients with high risk of bleeding. Apixaban had lower risk of bleeding compared to other DOAC in this population.

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Healthcare resource utilization and costs associated with venous thromboembolism in cancer patients treated with anticoagulants

Cited by 13 publications

References 26 publications

Cost-effectiveness analysis and budget impact of rivaroxaban compared with dalteparin in patients with cancer at risk of recurrent venous thromboembolism

Cost-effectiveness analysis and budget impact of rivaroxaban compared with dalteparin in patients with cancer at risk of recurrent venous thromboembolism

Use of New Oral Anticoagulants/ Direct Oral Anticoagulants in Malignant Patients

Direct oral anticoagulants for cancer‐associated venous thromboembolisms: a systematic review and network meta‐analysis

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