Abstract
BackgroundRecently, direct oral anticoagulants (DOACs) have been included in guidelines for the treatment of cancer-associated thrombosis (CAT) to be extended to suitable cancer patients. The purpose of this study was to compare the cost-effectiveness of using DOACs and low molecular weight heparins (LMWHs) for treating CAT from the perspective of the Chinese healthcare system.MethodsA Markov model was constructed to estimate the cost-effectiveness of the two strategies with a 6-month and 5-year time horizon. Input parameters were either sourced from the clinical trial, published literature. The primary outcome of the model was reported as incremental cost-effectiveness ratios (ICERs). Sensitivity analyses were performed to test model uncertainty.ResultsThe 6-month cost of DOACs was $ 654.65 with 0.40 quality adjusted life-years (QALYs) while the 6-month cost of LMWHs was $USD 1719.31 with 0.37 QALYs. Similarly, treatment with DOACs had a lower cost ($USD 657.85 vs. $USD 1716.56) and more health benefits (0.40 QALYs vs. 0.37 QALYs) than treatment with LMWHs in a subgroup of patients with gastrointestinal malignancy. We found treatment with DOACs would result in a large reduction in cost ($USD 1447.22 vs. $USD 3374.70) but a small reduction in QALYs (3.07 QALYs vs. 3.09 QALYs) compared with LMWHs over a 5-year time frame, resulting in an ICER of $USD 112895.50/QALYs. Sensitivity analysis confirmed the robustness of the results.ConclusionAs compared to LMWHs, DOACs can be a cost-saving anticoagulant choice for the treatment of CAT in the general oncology population and gastrointestinal malignancy population.
Highlights
Venous thromboembolic (VTE), which encompasses the diagnoses of both deep vein thrombosis (DVT) and pulmonary embolism (PE), is a common complication of malignancy associated with serious mortality, morbidity, and health economic consequences [1,2,3]
The incremental cost-effectiveness ratios (ICERs) of direct oral anticoagulants (DOACs) compared to low molecular weight heparins (LMWHs) was $ 112,895.50 per quality adjusted life-years (QALYs)
In the subgroup analysis of those patients with gastrointestinal malignancy, the results showed that DOACs were the preferred strategy over LMWHs with low cost ($ 657.85 vs. $1716.56) and high QALYs (0.40 QALYs vs. 0.37 QALYs)
Summary
Venous thromboembolic (VTE), which encompasses the diagnoses of both deep vein thrombosis (DVT) and pulmonary embolism (PE), is a common complication of malignancy associated with serious mortality, morbidity, and health economic consequences [1,2,3]. Patients with cancer are significantly more likely to develop VTE than in individuals without this disease, a ninefold increased risk is reported in such patients as compared with the normal population [4]. VTE is associated with a variety of adverse consequences including an increased risk of VTE recurrence, major bleeding in cancer patients. Direct oral anticoagulants (DOACs) have been included in guidelines for the treatment of cancer-associated thrombosis (CAT) to be extended to suitable cancer patients. The purpose of this study was to compare the cost-effectiveness of using DOACs and low molecular weight heparins (LMWHs) for treating CAT from the perspective of the Chinese healthcare system
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