Key result
Apixaban or rivaroxaban thromboprophylaxis in cancer patients yields similar costs and no meaningful QALY gains.
Why the study?
Apixaban and rivaroxaban are recommended for thromboprophylaxis in ambulatory cancer patients treated with chemotherapy, but their cost-utility compared to no thromboprophylaxis required assessment in Spain.
Does thromboprophylaxis with apixaban or rivaroxaban improve cost-utility compared to no thromboprophylaxis in ambulatory cancer patients starting chemotherapy with an intermediate-to-high risk of VTE?
Does thromboprophylaxis with apixaban or rivaroxaban improve cost-utility compared to no thromboprophylaxis in ambulatory cancer patients starting chemotherapy with an intermediate-to-high risk of VTE?
Effect estimate: Apixaban: saving of €64, gain of 0.008 QALYs; Rivaroxaban: expense of €121, gain of 0.008 QALYs
Cost-effectiveness analysis suggests that apixaban and rivaroxaban for VTE prophylaxis in ambulatory cancer patients on chemotherapy generate similar costs to no prophylaxis with minimal QALY gains.
Apixaban or rivaroxaban thromboprophylaxis yields similar costs with negligible QALY gains; leaves open value of routine use in Khorana ≥2 cancer patients.
BACKGROUND: Apixaban and rivaroxaban are two direct-acting oral anticoagulants (DOACs) recommended for thromboprophylaxis in cancer patients treated with chemotherapy in an ambulatory setting. We aimed to assess the cost-utility of thromboprophylaxis with apixaban and rivaroxaban vs no thromboprophylaxis in ambulatory cancer patients starting chemotherapy with an intermediate-to-high risk of venous thromboembolism (VTE), Khorana score ≥ 2 points. METHODS: A cost-effectiveness analysis was performed from the perspective of Spain's National Health System (NHS) using an analytical decision model in the short-term (180 days) and a Markov model in the long-term (5 years). Transition probabilities were obtained from randomized, double-blind, placebo-controlled clinical trials of apixaban and rivaroxaban in adult ambulatory patients with cancer at risk for VTE, treated with chemotherapy (AVERT and CASSINI trials). The costs (€2,021) were taken from Spanish sources. The utilities of the model were obtained through the EQ-5D questionnaire. Deterministic (base case) and probabilistic (second-order Monte Carlo simulation) analyses were conducted. RESULTS: In the probabilistic sensitivity analysis, apixaban generated a cost per patient of €1,082 ± 187, with a 95% confidence interval (CI) of €713-1,442, while no prophylaxis produced a cost per patient of €1,146 ± 218, with a 95% CI of €700-1,491, with a saving of €64 per patient and a gain of 0.008 QALYs. Likewise, rivaroxaban provided a cost per patient of €993 ± 133, with a 95% CI of €748-1,310, while no prophylaxis produced a cost per patient of €872 ± 152, with a 95% CI of €602-1,250, with an additional expense of €121 per patient and a gain of 0.008 QALYs. CONCLUSIONS: In thromboprophylaxis of cancer patients, the use of apixaban and rivaroxaban generated similar costs compared to non-prophylaxis, without the difference found being statistically significant, with a clinically insignificant QALY gain.
No takes yet. Share an insight, caveat, or question.
Martín et al. (2023) studied Cancer with intermediate-to-high risk of venous thromboembolism. Apixaban and rivaroxaban vs. No thromboprophylaxis was evaluated on Cost per patient and QALYs (Apixaban: saving of €64, gain of 0.008 QALYs; Rivaroxaban: expense of €121, gain of 0.008 QALYs). Thromboprophylaxis with apixaban or rivaroxaban in cancer patients generated similar costs compared to no prophylaxis, with a clinically insignificant gain of 0.008 QALYs.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: