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May 29, 2026Journal of Clinical Oncology

Value of risk-directed thromboprophylaxis in ambulatory lung and gastrointestinal cancer care: Economic evaluation of the TARGET-TP randomized trial.

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Why the study?

Thromboembolism is a major, preventable complication in cancer patients, and the cost-effectiveness and value for money of biomarker risk-directed thromboprophylaxis were evaluated.

Is biomarker risk-directed enoxaparin thromboprophylaxis cost-effective compared to usual care in ambulatory patients with lung and gastrointestinal cancer?

Population

Ambulatory patients with lung and gastrointestinal cancer receiving anticancer therapies

Comparison

Biomarker risk-directed enoxaparin thromboprophylaxis vs usual care (no prophylaxis)

Design

Within-trial and modelled economic evaluation of a phase III randomized trial

Follow-up

5-year horizon

Key result

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.

Authors

MAMarliese AlexanderAAAntonio Ahumada-CanaleKHKate Hadfield

Discussion

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Overview

Supports adoption of biomarker-driven enoxaparin thromboprophylaxis in lung and GI cancers; confirms economic dominance alongside RCT efficacy.

Key Points

  • This evaluation aims to assess the economic viability of biomarker-directed thromboprophylaxis in patients with lung and gastrointestinal cancer.
  • Conducted a within-trial and modelled cost-effectiveness analysis from the Australian health system perspective.
  • Used resource data to evaluate health benefits in quality-adjusted life years and applied bootstrapping for uncertainty analysis.
  • Employed a Markov model to project long-term costs and outcomes over a five-year period.
  • TARGET-TP intervention reduced costs by $1,095 per patient while gaining an additional 0.0097 QALYs, demonstrating dominance in over 83% of iterations.
  • Modelled analyses indicated savings of $3,551 per patient with a gain of 0.4 QALYs.
  • Probabilistic sensitivity analysis confirmed dominance in over 95% of iterations.

Study Design

Type

RCT

Structured PICO

Is biomarker risk-directed enoxaparin thromboprophylaxis cost-effective compared to usual care in ambulatory patients with lung and gastrointestinal cancer?

P
Population
Ambulatory patients with lung and gastrointestinal cancer receiving anticancer therapies
I
Intervention
Biomarker risk-directed enoxaparin thromboprophylaxis
C
Comparator
Usual care (no prophylaxis)
O
Outcome
Cost-effectiveness (costs and quality-adjusted life years [QALYs])

Main Result

Effect estimate: HR 0.31

p-value: p=0.005

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.

Cite This Study

Alexander et al. (2026) conducted an 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.

synapsesocial.com/papers/6a192da0fab5b468c44166eehttps://doi.org/10.1200/jco.2026.44.16_suppl.12137
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