Treatment of venous thromboembolism with vitamin K antagonists: patients’ health state valuations and treatment preferences

Abstract

Determining the optimal duration of vitamin K antagonist (VKA) therapy for patients with venous thromboembolism (VTE) requires a weighting of the benefits and risks of treatment. The objectives of our study were to investigate patient variability in health state valuations associated with VKA therapy and treatment preferences, and to investigate the extent to which valuations and treatment preferences are associated with prior experience with these health states and other patient characteristics. Valuations of outcomes after VTE scaled from 0 (tantamount to death) to 1 (tantamount to perfect health) were elicited from 53 patients who had experienced VTE, 23 patients who had experienced major bleeding during treatment, and 48 patients with the post-thrombotic syndrome. In addition, patients' treatment preferences were evaluated using treatment trade-off questions. Median health state valuations ranged from 0.33 for 'non-fatal haemorrhagic stroke' to 0.96 for 'no VKA treatment'. Variability between patients was substantial. Patients' treatment preferences also varied: 25% of patients chose cessation of treatment, regardless of the probability of recurrent VTE presented, whereas 23% of patients were never willing to choose cessation of treatment. Differences in valuations and treatment preferences were not associated with type of event experienced. Due to the substantial and unpredictable variability in valuations and treatment preferences, recommendations regarding treatment duration should be tailored to patients' specific values and concerns.

Economic Analysis of Rivaroxaban for the Treatment and Long-Term Prevention of Venous Thromboembolism in Portugal

“…The starting point in the modelling of utility was the population norm value of 0.825 (SD 0.17, n = 3395) established in the landmark UK EQ-5D survey, 34 which was used as an anchor point in this evaluation. The values used in the analysis were applied either as multipliers to the population norm value (DVT, PE, PTS, EC bleed and IC bleed) 35,36 or as straight values when derived using the EQ-5D or comparable methods (post-IC bleed and CTEPH) 37,38 (Table 2). A disutility associated with warfarin was not applied in the base-case, but was tested in a sensitivity analysis (0.988).…”

“…43 Therefore, oneway sensitivity analysis (OWSA) was carried out in order The 95% CIs for DVT, PE, EC bleeding and IC bleeding adjustments to utility norms have been assumed to equal the interquartile range because of the absence of further information and the size of the sample in Locadia et al 35 For the PSA, the parameters above were modelled as arising from independent beta distributions with alpha and beta parameters set such that the mean is the point estimate and the lower and upper values represent the 95% CI.…”

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

“…Utility decrements applied for CRNMB, non-ICH MB, ICH, and disability post-ICH were 5.00%, 31.58%, 65.26%, and 65.26% respectively. Utility value decrements of 13.68% and 30.00% were applied for every case of PTS [22] and CTEPH [23] respectively, for all subsequent cycles. For the few patients with both PTS and CTEPH, the utility decrements were taken into account multiplicatively.…”

Análisis coste-efectividad y coste-utilidad de apixaban frente a dabigatrán y rivaroxaban en el tratamiento y prevención secundaria del tromboembolismo venoso

“…La aparición de una hemorragia intracraneal o HPTEC se asoció con valores de utilidad de 0,330 [27] y 0,650 [28], respectivamente. Se consideraron también decrementos de utilidad asociados al desarrollo de eventos clínicos y sangrados, así como a la vía de administración del tratamiento anticoagulante, con un mayor impacto de la vía parenteral en la CVRS (Tabla 2) [27,[29][30][31][32][33].…”