Cost-effectiveness Of Apixaban In Prevention Research Articles

Cost-effectiveness of apixaban for prevention of venous thromboembolic events in patients after gynecologic cancer surgery

ObjectiveThe cost-effectiveness of apixaban was compared with enoxaparin for prevention of postoperative venothromboembolic events (VTE) in gynecologic oncology patients. Current guidelines recommend thromboprophylaxis with low molecular weight heparin for 28 days following gynecologic cancer surgery, but recent trials suggest that oral apixaban may be a safe, patient-preferred alternative. Apixaban was superior to enoxaparin in a Canadian cost-effectiveness analysis using orthopedics trial data. MethodsMedication costs, adherence rates, event rates, event costs, and utility decrements were estimated using prior clinical trial data and literature review for input into a short-term decision model to simulate outcomes in a hypothetical cohort of 1000 patients. Incremental cost-effectiveness ratios (ICERs) were calculated as net cost difference per quality-adjusted life year (QALY) gained. Input values at which net costs and QALYs were equivalent and ICERs at upper and lower bounds were evaluated. ResultsUsing aggregated costs, apixaban was less expensive and more effective than enoxaparin, and remained so or had high value in all scenarios on sensitivity analysis. Examining disaggregated ICERs, apixaban was cost-effective for deep venous thrombosis (DVT); of high value for clinically-relevant non-major bleeding (CRNMB) ($411); low value for major bleeding ($183,465), VTE-related death ($2,711,229), and all-cause mortality ($297,522); and not cost-effective for pulmonary embolism prevention. ConclusionsApixaban is more cost-effective than enoxaparin for the prevention of postoperative VTE in patients with gynecologic cancer. This appears to be driven largely by DVT and CRNMB prevention.

Cost-Effectiveness of Apixaban In Prevention of Stroke And Systemic Embolism In The Czech Republic

Apixaban is an oral anticoagulant, direct factor Xa inhibitor. The aim of the analysis was to compare costs and effectiveness of apixaban in the first line prevention of stroke and systemic embolism in vitamin K antagonist (VKA) suitable patients with atrial fibrillation. The analysis was conducted from the perspective of the public healthcare payer in the Czech Republic. To assess on cost-utility of apixaban, a Markov model was developed. The analysis was focused on the first line prevention of stroke and systemic embolism in VKA suitable patients suffering from atrial fibrillation with at least one risk factor present (age of 75 years or higher, diabetes mellitus, hypertension, symptomatic heart failure of class II or higher according to NYHA classification,). Hazard ratios used in the comparison were obtained from the ARISTOTLE double-blind head-to-head clinical trial. Apixaban was compared to warfarin in terms of lifetime costs per quality-adjusted life year. Drug costs, acute care costs, and management costs were assumed. In the base case scenario, the incremental cost-effectiveness ratio (ICER) of apixaban compared to warfarin reached 18 074 EUR/QALY. QALYs and LYs gained on apixaban treatment were 6.035 and 8,465 whereas patients on warfarin treatment gained only 5.851 and 8,288. Moreover, apixaban prevented the occurrence of most serious events as it reduced the number of strokes by 19 and bleeds by 65 (measured per 1000 patients). Our analysis demonstrated apixaban prolongs total survival and improves quality of life of VKA suitable patients with atrial fibrillation. Use of apixaban brought lower risk of serious events. Results indicate apixaban treatment is also very cost-effective as the ICER stays well below willingness to pay threshold.