Biomarker-driven primary thromboprophylaxis in lung and gastrointestinal cancer reduced thromboembolism (HR 0.31, p=0.005) and was cost-effective, saving $1,095 per patient and adding 0.0097 QALYs.
RCT
Is biomarker risk-directed enoxaparin thromboprophylaxis cost-effective compared to usual care in ambulatory patients with lung and gastrointestinal cancer?
Biomarker-driven primary thromboprophylaxis in patients with lung and gastrointestinal cancer is cost-saving and more effective than usual care from an Australian healthcare system perspective.
Effect estimate: HR 0.31
p-value: p=0.005
12137 Background: Thromboembolism (TE) is a major and preventable hematological complication in patients with cancer, contributing to substantial adverse health impacts for patients and the health system. Targeted Thromboprophylaxis in Ambulatory Patients Receiving Anticancer Therapies (TARGET-TP; ACTRN12618000811202) was an Australian phase III randomized trial of biomarker risk-directed enoxaparin thromboprophylaxis. The TARGET-TP intervention reduced TE (HR 0. 31, p = 0. 005) and six-month mortality (HR 0. 48, p = 0. 03) versus usual care (no prophylaxis). This study evaluated the value for money of the TARGET-TP intervention versus usual care. Methods: A within-trial and modelled economic evaluation was conducted from the Australian health system perspective. Resource use collected within the trial reflected risk stratification, thromboprophylaxis, side-effect management, and treatment of TE events. Health benefits were quantified as quality-adjusted life years (QALYs), utilities derived from SF-12v2 data. Bootstrapping was used to evaluate sampling uncertainty. A Markov model estimated long-term costs and outcomes over a 5-year horizon. Scenarios assessed the use of oral anticoagulants and stewardship, while probabilistic sensitivity analysis (PSA) tested parameter uncertainty. Results: Within-trial analysis showed the TARGET-TP intervention was associated with lower costs, while being more effective (i. e. , dominant), reducing costs by 1, 095 per patient and generating an additional 0. 0097 QALYs, driven mainly by fewer hospitalizations. The TARGET-TP intervention was dominant in > 83% of bootstrap iterations. Modelled analyses supported these findings, with cost savings of 3, 551 per patient and a gain of 0. 4 QALYs. PSA demonstrated dominance in > 95% of iterations (Figure 1). The oral anticoagulant and stewardship scenarios remained dominant for rivaroxaban, while apixaban was highly cost-effective, driven by bleeding events and drug costs. Conclusions: Biomarker-driven primary thromboprophylaxis in patients with lung and gastrointestinal cancer was less costly and more effective from the healthcare system perspective, supporting its implementation in routine care. Clinical trial information: ACTRN12618000811202.
Alexander et al. (Wed,) conducted a rct in Ambulatory lung and gastrointestinal cancer. Biomarker risk-directed enoxaparin thromboprophylaxis vs. Usual care (no prophylaxis) was evaluated on Thromboembolism (TE) (HR 0.31, p=0.005). Biomarker-driven primary thromboprophylaxis in lung and gastrointestinal cancer reduced thromboembolism (HR 0.31, p=0.005) and was cost-effective, saving $1,095 per patient and adding 0.0097 QALYs.