Análisis costo-efectividad de Apixaban versus Enoxaparina en pacientes sometidos a reemplazo total de cadera o rodilla en Colombia

Abstract

AimTo estimate the cost-effectiveness of apixaban versus enoxaparin to prevent venous thromboembolism (VTE) in patients undergoing total hip replacement (THR) or total knee replacement (TKR) in Colombia. Materials & methodsOur model included a decision tree for short-term outcomes and a Markov model for long-term outcomes. Epidemiological parameters and costs were taken from a Colombian health insurance company. Medicine dose were 2.5 mg of apixaban orally twice daily or 40 mg of enoxaparin subcutaneously once daily. Clinical efficacy and safety of medicines were taken from ADVANCE-1, ADVANCE-2 and ADVANCE-3 trials. Results of economic evaluation and Life Years Gained (LYG) were measured in QALYs. Time horizon was lifetime; discount rate for costs and health outcomes was 3.5%. A univariate and probabilistic sensitivity analysis was performed for the epidemiological parameters, effectiveness of interventions and costs ResultsWith apixaban, there would be 79 VTE events, 69 bleeding episodes, and 3.5 deaths. Total costs discounted were USD $ 282.50, LYG discounted were 4.56, and QALYs discounted were 3.67. With enoxaparin, there would be 134 TEV events, 81 bleeding episodes, and 6.0 deaths; total costs discounted were USD $ 394.89, LYG discounted were 4.55, and QALYs discounted were 3.66. The incremental cost-effectiveness ratio (ICER) shows that apixaban is a dominant strategy over enoxaparin. Acceptability curves show that on any willingness to pay, apixaban has a 100% chance of being chosen. DiscussionApixaban is a cost-saving thromboprophylaxis strategy in patients undergoing THR or TKR in Colombia, as it prevents more VTE events, bleeding, and all-cause death, generating more LYG and QALYs, and its discounted costs are lower.