Abstract
Malignancy is a well-established risk factor for venous thromboembolism and while low-molecular-weight heparin therapy has been standard of care for cancer-associated thrombosis for many years, many patients find injection therapy burdensome. The direct oral anticoagulant edoxaban has been shown to be noninferior to dalteparin for the treatment of cancer-associated thrombosis. In a Markov simulation model, edoxaban with 6-month time horizon and a United States societal perspective with 2017 US dollars, edoxaban was the preferred strategy in the general cancer population (6-month cost $6061 with 0.34 quality adjusted life years) and in a subgroup of patients with gastrointestinal malignancy (6-month cost $7227 with 0.34 quality adjusted life years). The incremental cost effectiveness ratio of dalteparin compared to edoxaban was $1,873,535 in the general oncology population and $694,058 in the gastrointestinal malignancy population.
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References
Cohen AT, Katholing A, Rietbrock S, Bamber L, Martinez C (2017) Epidemiology of first and recurrent venous thromboembolism in patients with active cancer. A population-based cohort study. Thromb Haemost 117(1):57–65
Lee AY, Levine MN, Baker RI et al (2003) Low-molecular-weight heparin versus a coumarin for the prevention of recurrent venous thromboembolism in patients with cancer. N Engl J Med 349(2):146–153
Connell NT, Abel GA, Connors JM (2017) Low-molecular weight heparin versus vitamin K antagonists for the treatment of cancer-associated thrombosis: a cost-effectiveness analysis. Thromb Res 150:53–58
Shah S, Rubin N, Khorana AK. Economic burden of venous thromboembolism in cancer patients—a comparative analysis between matched patients with cancer with and without a diagnosis of venous thromboembolism. Blood. 2018;132(366):Abstract 366
Raskob GE, van Es N, Verhamme P et al (2018) Edoxaban for the treatment of cancer-associated venous thromboembolism. N Engl J Med 378(7):615–624
Young AM, Marshall A, Thirlwall J et al (2018) Comparison of an oral factor Xa inhibitor with low molecular weight heparin in patients with cancer with venous thromboembolism: results of a randomized trial (SELECT-D). J Clin Oncol 36(20):2017–2023
Aujesky D, Smith KJ, Cornuz J, Roberts MS (2005) Cost-effectiveness of low-molecular-weight heparin for secondary prophylaxis of cancer-related venous thromboembolism. Thromb Haemost 93(3):592–599
Dalteparin. In: RED BOOK Online [database on the Internet]. Greenwood Village (CO): Truven health analytics; January 15, 2018. www.micromedexsolutions.com
Edoxaban. In: RED BOOK Online [database on the Internet]. Greenwood Village (CO): Truven health analytics; January 15, 2018. www.micromedexsolutions.com
Shah A, Shewale A, Hayes CJ, Martin BC (2016) Cost-effectiveness of oral anticoagulants for ischemic stroke prophylaxis among nonvalvular atrial fibrillation patients. Stroke 47(6):1555–1561
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NTC and JMC designed the study, analyzed the data, critically evaluated and edited the manuscript, and provided final approval. NTC built the Markov model and ran the analyses.
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NT.C.: no financial conflicts of interest. J.M.C.: Honoraria or consulting fees from Bristol-Myers Squibb, Portola, Research funding to the institution CSL Behring.
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Connell, N.T., Connors, J.M. Cost-effectiveness of edoxaban versus dalteparin for the treatment of cancer-associated thrombosis. J Thromb Thrombolysis 48, 382–386 (2019). https://doi.org/10.1007/s11239-019-01903-z
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DOI: https://doi.org/10.1007/s11239-019-01903-z