PCV23 COST ANALYSIS OF DIRECT ORAL ANTICOAGULANTS BETRIXABAN AND RIVAROXABAN VERSUS ENOXAPARIN FOR THE PREVENTION OF VENOUS THROMBOEMBOLISM (VTE) IN ACUTE MEDICALLY ILL HOSPITALIZED PATIENTS

Abstract

Acute medically ill patients are at high risk for venous thromboembolism (VTE). Subcutaneous enoxaparin is the ‘gold’ standard therapy in these patients. Recently, two direct oral anticoagulants have been approved for this indication by the FDA; betrixaban (2017) and rivaroxaban (2019). The aim of this study was to perform a cost analysis of betrixaban and rivaroxaban versus enoxaparin for VTE prophylaxis. Cost estimates of betrixaban, rivaroxaban, and enoxaparin were obtained from publicly available sources (CMMS, Drugs.com). Cost estimates for clinical outcomes were garnered from literature and public databases (CMMS). Data from key trials (betrixaban: APEX; rivaroxaban: MAGELLAN) were utilized to determine probabilities of potential clinical outcomes. Decision tree models were constructed (TreeagePro®) for analysis of each therapy relative to enoxaparin. Doses/regimens were consistent with approved labeling. Costs were reported in 2019 United States currency (USD) and the study was performed from a societal prospective. Discount rate was 5%. Monte Carlo (probabilistic sensitivity) analyses was performed. Results are expressed as expected value (EV) or the average cost for each treatment strategy. Two-way sensitivity analyses using 50% to 200% of the key VTE clinical outcomes was performed. The EV or lowest cost strategy, for the comparison of enoxaparin to betrixaban favored enoxaparin ($1,046 versus $1,209; 13.4% difference) using probabilities from the APEX study. The EV for the comparison of enoxaparin to rivaroxaban favored enoxaparin ($1,271 versus $1,650; 22.3% difference). In acute medically ill hospitalized patients at risk for VTE, the EV of enoxaparin was more optimal than either betrixaban or rivaroxaban based upon clinical trial results. These results are valuable in guiding effective clinical decision making and assessments for formulary inclusion. As further clinical outcome data becomes available, it is recommended that similar analyses be repeated to better model real-world settings.