Key result
Apixaban and rivaroxaban resulted in lower total costs than LMWH/VKA when applying broader health care or societal cost perspectives, despite having higher drug costs.
Why the study?
Optimal use of limited healthcare resources requires economic analyses, but the choice of cost perspective can substantially influence findings. The study aimed to illustrate cost differences across perspectives for oral anticoagulants in venous thromboembolism.
Does the choice of cost perspective affect the economic evaluation of NOACs versus LMWH/VKA in patients with VTE?
Does the choice of cost perspective affect the economic evaluation of NOACs versus LMWH/VKA in patients with VTE?
When evaluating the cost-effectiveness of VTE treatments, applying a broader societal perspective rather than just drug costs favors NOACs like apixaban and rivaroxaban over LMWH/VKA.
Answers are grounded in this paper and cite their sources.
May inform anticoagulation choices when total rather than drug costs are considered; extends economic models but leaves open prospective validation.
Aim: Optimal use of scarce resources is a focus in the healthcare sector, as resources devoted to health care are limited. Costs and health economic analyses can help guide decision-making concerning treatments. One important factor is the choice of cost perspective that can range from a focus on narrow drug budget costs to broader economic perspectives. In the case of treatment with oral anticoagulants in patients with venous thromboembolism (VTE), encompassing deep vein thrombosis and pulmonary embolism, the aim of this cost analysis was to illustrate the differences in costs when applying different cost perspectives.Methods: In a cost analysis, pairwise comparisons of average costs of 6 months standard treatment with either a low molecular weight heparin parenteral anticoagulant (LMWH) and a Vitamin K Antagonist (VKA) versus one of the non-vitamin K oral anticoagulants [NOACs; dabigatran etexilate, rivaroxaban, apixaban, and edoxaban) used in daily clinical practice in Denmark for VTE patients were carried out. Each analysis included the results from five different cost analyses with increasingly broader cost perspectives going from the narrowest “drug cost only” perspective to the broadest “societal” perspective.Results: Focusing on “drug costs only”, LMWH/VKA was associated with the lowest costs compared to all NOACs. However, including the economic impact of preventing recurrent VTE and limit bleedings, apixaban and rivaroxaban resulted in slightly lower health care costs than LMWH/VKA. When applying the “societal perspective”, the total costs saved with apixaban and rivaroxaban compared to LMWH/VKA further increased, with apixaban having the lowest total costs.Conclusions: The present study’s case of oral anticoagulants in VTE treatment illustrated the importance of the cost perspective in the choice of therapy. If decision-making were based on drug costs only, instead of applying a health care sector or societal cost perspective, suboptimal decisions may be likely.
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Nielsen et al. (2019) studied venous thromboembolism (VTE). NOACs (dabigatran, rivaroxaban, apixaban, edoxaban) vs. LMWH and a Vitamin K Antagonist (VKA) was evaluated on average costs from different cost perspectives. Apixaban and rivaroxaban resulted in lower total costs than LMWH/VKA when applying broader health care or societal cost perspectives, despite having higher drug costs.
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