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Dalteparin or vitamin K antagonists to prevent recurrent venous thromboembolism in cancer patients: a patient-level economic analysis for France and Austria

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Abstract

Background

International guidelines recommend extended duration secondary prophylaxis in cancer patients who develop primary venous thromboembolism (VTE). Agent selection is guided in part by one large randomized trial (i.e., CLOT; Lee et al., N Engl J Med 349:146–53, 2003) which demonstrated that dalteparin reduced the relative risk of recurrence by 52% compared with oral vitamin K antagonists (VKA; HR = 0.48, 95% CI, 0.30 to 0.77). In a subgroup analysis from that same trial, patients with renal impairment also derived benefit with dalteparin (VTE rates = 3% vs. 17%; p = 0.011). To measure the economic value of secondary VTE prophylaxis with dalteparin, a patient-level pharmacoeconomic analysis was conducted from the Austrian and French healthcare system perspectives.

Methods

Chapter 1 Healthcare resource use collected during the CLOT trial was extracted and converted into direct cost estimates. Incremental cost differences between the dalteparin and VKA groups were then combined with health state utilities to measure the cost per quality-adjusted life year (QALY) gained.

Results

The dalteparin group had significantly higher costs than the VKA group in both countries (Austria: dalteparin = €2687 vs. VKA = €2012; France: dalteparin = €2053 vs. VKA = €1352: p < 0.001). However, when the incremental costs were combined with the utility gain, dalteparin had a cost of €6600 and €4900 per QALY gained in Austria and France, respectively. The analyses in patients with renal impairment suggested an even better economic profile, with the cost per QALY gained being less than €4000 in both countries.

Conclusions

Secondary prophylaxis with dalteparin is a cost-effective alternative to VKA for the prevention of recurrent VTE in patients with cancer.

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Authors and Affiliations

  1. Augmentium Pharma Consulting Inc, 283 Danforth Ave, Suite 448 M4K 1N2, Toronto, Canada

    George Dranitsaris

  2. Pfizer Inc, New York, NY, USA

    Lesley G Shane & Seth Woodruff

  3. Montpellier University Hospital, Montpellier, France

    Jean-Philippe Galanaud

  4. Vienna General Hospital, Vienna, Austria

    Gunar Stemer

  5. Institut Sainte Catherine, Avignon, France

    Philippe Debourdeau

Authors
  1. George Dranitsaris
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  2. Lesley G Shane
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  3. Jean-Philippe Galanaud
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  4. Gunar Stemer
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  5. Philippe Debourdeau
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  6. Seth Woodruff
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Corresponding author

Correspondence to George Dranitsaris.

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Conflict of interest

Funding for this study was provided by Pfizer Inc. Some of the authors (LS and SW) are employees of the sponsor. The corresponding author had full access to the data, designed the study, conducted the analysis, interpreted the results, and had the final responsibility for the decision to submit the paper for peer-reviewed publication. There are no other conflicts of interest to declare.

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Dranitsaris, G., Shane, L.G., Galanaud, JP. et al. Dalteparin or vitamin K antagonists to prevent recurrent venous thromboembolism in cancer patients: a patient-level economic analysis for France and Austria. Support Care Cancer 25, 2093–2102 (2017). https://doi.org/10.1007/s00520-017-3610-2

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  • DOI: https://doi.org/10.1007/s00520-017-3610-2

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