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Cost–utility analysis of apixaban compared with usual care for primary thromboprophylaxis in ambulatory patients with cancer
BACKGROUND: Apixaban (2.5 mg) taken twice daily has been shown to substantially reduce the risk of venous thromboembolism (VTE) compared with placebo for the primary thromboprophylaxis of ambulatory patients with cancer who are starting chemotherapy and are at intermediate-to-high risk of VTE. We ai...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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CMA Joule Inc.
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8568073/ https://www.ncbi.nlm.nih.gov/pubmed/35040802 http://dx.doi.org/10.1503/cmaj.210523 |
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author | Kimpton, Miriam Kumar, Srishti Wells, Philip S. Coyle, Doug Carrier, Marc Thavorn, Kednapa |
author_facet | Kimpton, Miriam Kumar, Srishti Wells, Philip S. Coyle, Doug Carrier, Marc Thavorn, Kednapa |
author_sort | Kimpton, Miriam |
collection | PubMed |
description | BACKGROUND: Apixaban (2.5 mg) taken twice daily has been shown to substantially reduce the risk of venous thromboembolism (VTE) compared with placebo for the primary thromboprophylaxis of ambulatory patients with cancer who are starting chemotherapy and are at intermediate-to-high risk of VTE. We aimed to compare the health system costs and health benefits associated with primary thromboprophylaxis using apixaban with those associated with the current standard of care (where no primary thromboprophylaxis is given), from the perspective of Canada’s publicly funded health care system in this subpopulation of patients with cancer over a lifetime horizon. METHODS: We performed a cost–utility analysis to estimate the incremental cost per quality-adjusted life-year (QALY) gained with primary thromboprophylaxis using apixaban. We obtained baseline event rates and the efficacy of apixaban from the Apixaban for the Prevention of Venous Thromboembolism in High-Risk Ambulatory Cancer Patients (AVERT) trial on apixaban prophylaxis. We estimated relative risk for bleeding, risk of complications associated with VTE treatment, mortality rates, costs and utilities from other published sources. RESULTS: Over a lifetime horizon, apixaban resulted in lower costs to the health system (Can$7902.98 v. Can$14 875.82) and an improvement in QALYs (9.089 v. 9.006). The key driver of cost–effectiveness results was the relative risk of VTE as a result of apixaban. Results from the probabilistic analysis showed that at a willingness to pay of Can$50 000 per QALY, the strategy with the highest probability of being most cost-effective was apixaban, with a probability of 99.87%. INTERPRETATION: We found that apixaban is a cost-saving option for the primary thromboprophylaxis of ambulatory patients with cancer who are starting chemotherapy and are at intermediate-to-high risk of VTE. |
format | Online Article Text |
id | pubmed-8568073 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | CMA Joule Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-85680732021-11-05 Cost–utility analysis of apixaban compared with usual care for primary thromboprophylaxis in ambulatory patients with cancer Kimpton, Miriam Kumar, Srishti Wells, Philip S. Coyle, Doug Carrier, Marc Thavorn, Kednapa CMAJ Research BACKGROUND: Apixaban (2.5 mg) taken twice daily has been shown to substantially reduce the risk of venous thromboembolism (VTE) compared with placebo for the primary thromboprophylaxis of ambulatory patients with cancer who are starting chemotherapy and are at intermediate-to-high risk of VTE. We aimed to compare the health system costs and health benefits associated with primary thromboprophylaxis using apixaban with those associated with the current standard of care (where no primary thromboprophylaxis is given), from the perspective of Canada’s publicly funded health care system in this subpopulation of patients with cancer over a lifetime horizon. METHODS: We performed a cost–utility analysis to estimate the incremental cost per quality-adjusted life-year (QALY) gained with primary thromboprophylaxis using apixaban. We obtained baseline event rates and the efficacy of apixaban from the Apixaban for the Prevention of Venous Thromboembolism in High-Risk Ambulatory Cancer Patients (AVERT) trial on apixaban prophylaxis. We estimated relative risk for bleeding, risk of complications associated with VTE treatment, mortality rates, costs and utilities from other published sources. RESULTS: Over a lifetime horizon, apixaban resulted in lower costs to the health system (Can$7902.98 v. Can$14 875.82) and an improvement in QALYs (9.089 v. 9.006). The key driver of cost–effectiveness results was the relative risk of VTE as a result of apixaban. Results from the probabilistic analysis showed that at a willingness to pay of Can$50 000 per QALY, the strategy with the highest probability of being most cost-effective was apixaban, with a probability of 99.87%. INTERPRETATION: We found that apixaban is a cost-saving option for the primary thromboprophylaxis of ambulatory patients with cancer who are starting chemotherapy and are at intermediate-to-high risk of VTE. CMA Joule Inc. 2021-10-12 /pmc/articles/PMC8568073/ /pubmed/35040802 http://dx.doi.org/10.1503/cmaj.210523 Text en © 2021 CMA Joule Inc. or its licensors https://creativecommons.org/licenses/by-nc-nd/4.0/This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY-NC-ND 4.0) licence, which permits use, distribution and reproduction in any medium, provided that the original publication is properly cited, the use is noncommercial (i.e., research or educational use), and no modifications or adaptations are made. See: https://creativecommons.org/licenses/by-nc-nd/4.0/ |
spellingShingle | Research Kimpton, Miriam Kumar, Srishti Wells, Philip S. Coyle, Doug Carrier, Marc Thavorn, Kednapa Cost–utility analysis of apixaban compared with usual care for primary thromboprophylaxis in ambulatory patients with cancer |
title | Cost–utility analysis of apixaban compared with usual care for primary thromboprophylaxis in ambulatory patients with cancer |
title_full | Cost–utility analysis of apixaban compared with usual care for primary thromboprophylaxis in ambulatory patients with cancer |
title_fullStr | Cost–utility analysis of apixaban compared with usual care for primary thromboprophylaxis in ambulatory patients with cancer |
title_full_unstemmed | Cost–utility analysis of apixaban compared with usual care for primary thromboprophylaxis in ambulatory patients with cancer |
title_short | Cost–utility analysis of apixaban compared with usual care for primary thromboprophylaxis in ambulatory patients with cancer |
title_sort | cost–utility analysis of apixaban compared with usual care for primary thromboprophylaxis in ambulatory patients with cancer |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8568073/ https://www.ncbi.nlm.nih.gov/pubmed/35040802 http://dx.doi.org/10.1503/cmaj.210523 |
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