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Dalteparin versus Warfarin for the Prevention of Recurrent Venous Thromboembolic Events in Cancer Patients

A Pharmacoeconomic Analysis

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Abstract

Objective: In a recent randomised trial (CLOT [Comparison of Low molecular weight heparin versus Oral anticoagulant Therapy for long term anticoagulation in cancer patients with venous thromboembolism]), which evaluated secondary prophylaxis of venous thromboembolism (VTE) in cancer patients, dalteparin reduced the relative risk of recurrent VTEs by 52% compared with oral anticoagulation therapy (p = 0.002). A Canadian pharmacoeconomic analysis was conducted to measure the economic value of dalteparin for this indication.

Design: The study was conducted from the Canadian healthcare system. The first part of this study utilised the CLOT trial database, from which resource utilisation data were converted into Canadian cost estimates ($Can, year 2005 values). Univariate and multivariate regression analyses were conducted to compare the total cost of therapy between patients randomised to treatment with dalteparin or oral therapy. Health state utilities and treatment preferences were then measured in 24 oncology care providers using the time trade-off technique.

Results: When all of the cost components were combined for the entire population (n = 676), patients in the dalteparin group had significantly higher overall costs than the control group ($Can4162 vs $Can2003; p < 0.001). The preference assessment revealed that 23 of 24 respondents (96%) selected dalteparin over warfarin, with an associated gain of 0.157 QALYs. When the incremental cost of dalteparin ($Can2159 per patient) was combined with the QALY gain, the findings revealed that dalteparin was associated with a cost of approximately $Can13 800 (95% CI 12 400, 15 100) per QALY gained.

Conclusions: Given the practical advantages of dalteparin in terms of convenience, improved efficacy and the acceptable economic value, this analysis suggests that long-term dalteparin therapy is a sound alternative to warfarin for the prevention of recurrent VTEs in patients with cancer

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References

  1. Kearon C. Natural history of venous thromboembolism. Circulation 2003; 107 Suppl. 1: 122–130

    Article  Google Scholar 

  2. Deitcher SR. Cancer-related deep venous thrombosis: clinical importance, treatment challenges, and management strategies. Semin Thromb Hemostasis 2003; 29: 247–258

    Article  Google Scholar 

  3. Sallah S, Wan JY, Nguyen NP. Venous thrombosis in patients with solid tumors: determination of frequency and characteristics. Thromb Haemost 2002; 87: 575–579

    PubMed  CAS  Google Scholar 

  4. National Cancer Institute of Canada. Canadian Cancer Statistics 2004. Toronto, 2004 [online]. Available from URL: http://www.cancer.ca [Accessed 2005 Feb 4]

    Google Scholar 

  5. Lee AY, Levine MN, Baker RI, et al. Low-molecular-weight heparin versus a coumarin for the prevention of recurrent venous thromboembolism in patients with cancer. N Engl J Med 2003; 349: 146–153

    Article  PubMed  CAS  Google Scholar 

  6. Lee A YY, Rickles FR, Julian JA, et al. Randomized comparison of low molecular weight heparin and coumarin derivatives on the survival of patients with cancer and venous thromboembolism. J Clin Oncol 2005; 23: 2123–2129

    Article  PubMed  CAS  Google Scholar 

  7. Klerk CP, Smorenburg SM, Otten HM, et al. The effect of low molecular weight heparin on survival in patients with advanced malignancy. J Clin Oncol 2005; 23: 2130–2135

    Article  PubMed  CAS  Google Scholar 

  8. Kakkar AK, Levine MN, Kadziola Z, et al. Low molecular weight heparin, therapy with dalteparin, and survival in advanced cancer: the Fragmin Advanced Malignancy Outcome Study (FAMOUS). J Clin Oncol 2004; 22: 1944–1948

    Article  PubMed  CAS  Google Scholar 

  9. O’Brien BJ, Anderson DR, Goeree R. Cost-effectiveness of enoxaparin versus warfarin prophylaxis against deep-vein thrombosis after total hip replacement. CMAJ 1994; 150: 1083–1090

    PubMed  Google Scholar 

  10. Haentjens P, De Groote K, Annemans L. Prolonged enoxaparin therapy to prevent venous thromboembolism after primary hip or knee replacement: a cost-utility analysis. Arch Orthop Trauma Surg 2004; 124: 507–517

    Article  PubMed  Google Scholar 

  11. Botteman MF, Caprini J, Stephens JM, et al. Results of an economic model to assess the cost-effectiveness of enoxaparin, a low-molecular-weight heparin, versus warfarin for the prophylaxis of deep vein thrombosis and associated long-term complications in total hip replacement surgery in the United States. Clin Ther 2002; 24: 1960–1986

    Article  PubMed  CAS  Google Scholar 

  12. Hull RD, Pineo GF, Raskob GE. The economic impact of treating deep vein thrombosis with low molecular weight heparin: outcome of therapy and health economic aspects. Haemostasis 1998; 28 Suppl. 3: 8–16

    PubMed  CAS  Google Scholar 

  13. Gordois A, Posnett J, Borris L, et al. The cost effectiveness of fondaparinux compared with enoxaparin as prophylaxis against thromboembolism following major orthopedic surgery. J Thromb Haemost 2003; 1: 2167–2174

    Article  PubMed  CAS  Google Scholar 

  14. Dranitsaris G, Kahn S, Sturrpo C, et al. Pharmacoeconomic analysis of fondaparinux versus enoxaparin for the prevention of thromboembolic events in orthopedic surgery patients. Am J Cardiovasc Drugs 2004; 4: 325–333

    Article  PubMed  Google Scholar 

  15. Dranitsaris G. The cost of blood transfusions in cancer patients: a reanalysis of a Canadian economic evaluation. J Oncol Pharm Prac 2000; 6: 1–6

    Google Scholar 

  16. Statistics Canada [online]. Available from URL: http://www.statcan.ca [Accessed 2005 Feb 4]

  17. Torrance GW. Utility approach to measuring health-related quality of life. J Chronic Dis 1987; 40: 593–600

    Article  PubMed  CAS  Google Scholar 

  18. Gafni A. Alternatives to the QAL Y measure for economic evaluations. Support Care Cancer 1997; 5: 105–111

    Article  PubMed  CAS  Google Scholar 

  19. Leung P, Tanock IF, Oza AM, et al. Cost utility analysis of chemotherapy using paclitaxel, docetaxel or vinorelbine for patients with anthracycline-resistant breast cancer. J Clin Oncol 1999; 17: 3082–3090

    PubMed  CAS  Google Scholar 

  20. Ortega A, Dranitsaris G, Sturgeon J, et al. Cost utility analysis of paclitaxel in combination with cisplatin for patients with advanced ovarian cancer. Gynecol Oncol 1997; 66: 454–463

    Article  PubMed  CAS  Google Scholar 

  21. Laupacis A, Feeny D, Detsky AS, et al. How attractive does a new technology have to be to warrant adoption and utilization? Tentative guidelines for using clinical and economic evaluations. CMAJ 1992; 146: 473–481

    PubMed  CAS  Google Scholar 

  22. Aujesky D, Smith KJ, Cornuz J, et al. Cost effectiveness of low molecular weight heparin for secondary prophylaxis of cancer related venous thromboembolism. Thromb Haemost 2005; 93: 592–599

    PubMed  CAS  Google Scholar 

  23. Martin SC, Gagnon DD, Zhang L, et al. Cost-utility analysis of survival with epoetin-alfa versus placebo in stage IV breast cancer. Pharmacoeconomics 2003; 21: 1153–1169

    Article  PubMed  Google Scholar 

  24. Silber JH, Fridman M, Shpilsky A, et al. Modeling the cost-effectiveness of granulocyte colony-stimulating factor use in early-stage breast cancer. J Clin Oncol 1998; 16: 2435–2444

    PubMed  CAS  Google Scholar 

  25. Anderson FA, Speneer FA. Risk factors for venous thromboembolism. Circulation 2003; 107: 19–116

    Article  Google Scholar 

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Acknowledgements

The authors would like to express their gratitude to the local investigators who administered the health-utility assessment. This study was funded via a research grant from Pfizer Canada, Inc. to the principal investigator, following an RFP (request for proposal).

Once the study had begun, an arms-length approach was taken with the sponsor. The principal investigator retained the right to publish the findings of a study in a journal of his choosing.

G. Dranitsaris, M. Vincent and M. Crowther have acted as consultants to Pfizer Canada, Inc. The corresponding author had full access to all the data in the study and final responsibility for the decision to submit the paper.

Contribution of each author.

G. Dranitsaris: study design, development of data collection instrument, statistical analysis and preparation of manuscript.

M. Vincent: study design, development of data collection instrument and contribution to manuscript development and review. Also provided clinical expertise and guidance on the analysis.

M. Crowther: provided clinical expertise and guidance on the analysis. Contributed to the development and review of the manuscript.

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Authors and Affiliations

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

    George Dranitsaris

  2. London Regional Cancer Centre, London, Ontario, Canada

    Mark Vincent

  3. St Joseph’s Hospital, Hamilton, Ontario, Canada

    Mark Crowther

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  1. George Dranitsaris
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  2. Mark Vincent
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  3. Mark Crowther
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Correspondence to George Dranitsaris.

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Dranitsaris, G., Vincent, M. & Crowther, M. Dalteparin versus Warfarin for the Prevention of Recurrent Venous Thromboembolic Events in Cancer Patients. Pharmacoeconomics 24, 593–607 (2006). https://doi.org/10.2165/00019053-200624060-00006

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