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Cost effectiveness analysis of direct oral anticoagulant (DOAC) versus dalteparin for the treatment of cancer associated thrombosis (CAT) in the United States.
- Source :
-
Thrombosis research [Thromb Res] 2019 Aug; Vol. 180, pp. 37-42. Date of Electronic Publication: 2019 May 16. - Publication Year :
- 2019
-
Abstract
- Introduction: While trials have demonstrated non-inferiority of direct oral anticoagulant drugs (DOAC) to low-molecular-weight heparins (LMWH) for the treatment of cancer associated thrombosis (CAT), it is unclear if the newer intervention is cost-effective.<br />Methods: We performed a cost-utility analysis using a Markov state-transition model over a time horizon of 60 months in a hypothetical cohort of 65-year-old patients with active malignancy and first acute symptomatic CAT who were eligible to receive either rivaroxaban/edoxaban or dalteparin. We obtained transition probability, relative risk, cost, and utility inputs from the literature. We estimated the differential impact on costs and quality-adjusted life years (QALYs) per patient and performed one-way and probabilistic sensitivity analyses to test the robustness of results.<br />Results: Using the base-case analysis over 60 months, DOAC versus dalteparin was associated with an incremental cost reduction of $24,129 with an incremental QALY reduction of 0.04. In the one-way sensitivity analysis, the cost of dalteparin contributed the most to the incremental cost difference; relative risk of death related to underlying cancer contributed the most of the incremental QALY difference. The probabilistic sensitivity analysis confirmed the base-case analysis, with a large reduction in cost but small reduction in QALYs.<br />Conclusion: Rivaroxaban or edoxaban as compared to dalteparin is cost saving from a payer's perspective for the treatment of CAT. Professional organizations and healthcare systems may want to consider this analysis in future practice recommendations.<br /> (Copyright © 2019 Elsevier Ltd. All rights reserved.)
- Subjects :
- Anticoagulants economics
Cost-Benefit Analysis
Dalteparin economics
Factor Xa Inhibitors economics
Humans
Neoplasms complications
Pyridines economics
Quality-Adjusted Life Years
Rivaroxaban economics
Thiazoles economics
Thrombosis complications
Thrombosis economics
Anticoagulants therapeutic use
Dalteparin therapeutic use
Factor Xa Inhibitors therapeutic use
Pyridines therapeutic use
Rivaroxaban therapeutic use
Thiazoles therapeutic use
Thrombosis drug therapy
Subjects
Details
- Language :
- English
- ISSN :
- 1879-2472
- Volume :
- 180
- Database :
- MEDLINE
- Journal :
- Thrombosis research
- Publication Type :
- Academic Journal
- Accession number :
- 31200341
- Full Text :
- https://doi.org/10.1016/j.thromres.2019.05.012