New Oral Anticoagulants Versus Low Molecular Weight Heparins for the Treatment of Cancer-associated Thrombosis: a Cost-effectiveness Analysis

2021 ◽  
Author(s):  
Kaidireyahan Wumaier ◽  
Wenqian Li ◽  
Naifei Chen ◽  
Jiuwei Cui
Keyword(s):  
Molecular Weight ◽  
Cost Effectiveness ◽  
Oral Anticoagulants ◽  
New Oral Anticoagulants ◽  
Low Molecular Weight ◽  
Test Model ◽  
Low Molecular Weight Heparins ◽  
Gastrointestinal Malignancy ◽  
Cancer Associated Thrombosis ◽  
The Cost

Abstract Background: Recently, new oral anticoagulants (NOACs) have been included in guidelines for the treatment of cancer-associated thrombosis (CAT) to be extended to suitable cancer patients. The purpose of this study was to compare the cost-effectiveness of using NOACs and low molecular weight heparins(LMWHs) for treating CAT from the perspective of the Chinese healthcare system. Methods: A Markov model was constructed to estimate the cost-effectiveness of the two strategies with a 6-month and 5-year time horizon. Input parameters were either sourced from the clinical trial, published literature. The primary outcome of the model was reported as incremental cost-effectiveness ratios (ICERs). Sensitivity analyses were performed to test model uncertainty. Results: The 6-month cost of NOACs was $ 654.65 with 0.40 QALYs while the 6-month cost of LMWHs was $ 1719.31 with 0.37 QALYs. Similarly, treatment with NOACs had a lower cost ($ 657.85 vs. $ 1716.56) and more health benefits (0.40 QALY vs. 0.37 QALY) than treatment with LMWHs in a subgroup of patients with gastrointestinal malignancy. We found treatment with NOACs would result in a large reduction in cost($ 1447.22 vs. $ 3374.70) but a small reduction in QALYs (3.07 QALY vs. 3.09 QALY) compared with LMWHs over a 5-year time frame, resulting in an ICER of $ 112895.50/QALY. Sensitivity analysis confirmed the robustness of the results. Conclusion: As compared to LMWHs, NOACs can be a cost-saving anticoagulant choice for the treatment of CAT in the general oncology population and gastrointestinal malignancy population.Classification codes: I.

scholarly journals Direct oral anticoagulants versus low molecular weight heparins for the treatment of cancer-associated thrombosis: a cost-effectiveness analysis

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Kaidireyahan Wumaier ◽  
Wenqian Li ◽  
Naifei Chen ◽  
Jiuwei Cui
Keyword(s):  
Molecular Weight ◽  
Cost Effectiveness ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Low Molecular Weight ◽  
Test Model ◽  
Low Molecular Weight Heparins ◽  
Gastrointestinal Malignancy ◽  
Cancer Associated Thrombosis ◽  
The Cost

Abstract Background Recently, direct oral anticoagulants (DOACs) have been included in guidelines for the treatment of cancer-associated thrombosis (CAT) to be extended to suitable cancer patients. The purpose of this study was to compare the cost-effectiveness of using DOACs and low molecular weight heparins (LMWHs) for treating CAT from the perspective of the Chinese healthcare system. Methods A Markov model was constructed to estimate the cost-effectiveness of the two strategies with a 6-month and 5-year time horizon. Input parameters were either sourced from the clinical trial, published literature. The primary outcome of the model was reported as incremental cost-effectiveness ratios (ICERs). Sensitivity analyses were performed to test model uncertainty. Results The 6-month cost of DOACs was $ 654.65 with 0.40 quality adjusted life-years (QALYs) while the 6-month cost of LMWHs was $USD 1719.31 with 0.37 QALYs. Similarly, treatment with DOACs had a lower cost ($USD 657.85 vs. $USD 1716.56) and more health benefits (0.40 QALYs vs. 0.37 QALYs) than treatment with LMWHs in a subgroup of patients with gastrointestinal malignancy. We found treatment with DOACs would result in a large reduction in cost ($USD 1447.22 vs. $USD 3374.70) but a small reduction in QALYs (3.07 QALYs vs. 3.09 QALYs) compared with LMWHs over a 5-year time frame, resulting in an ICER of $USD 112895.50/QALYs. Sensitivity analysis confirmed the robustness of the results. Conclusion As compared to LMWHs, DOACs can be a cost-saving anticoagulant choice for the treatment of CAT in the general oncology population and gastrointestinal malignancy population.

scholarly journals Safety and efficacy of new oral anticoagulants and low-molecular-weight heparins compared with aspirin in patients undergoing total knee and hip replacements

2016 ◽  
Vol 25 (11) ◽  
pp. 1245-1252 ◽  
Author(s):  
Johannes T. H. Nielen ◽  
Pieter C. Dagnelie ◽  
Pieter J. Emans ◽  
Nicole Veldhorst-Janssen ◽  
Arief Lalmohamed ◽  
...  
Keyword(s):  
Molecular Weight ◽  
Oral Anticoagulants ◽  
New Oral Anticoagulants ◽  
Low Molecular Weight ◽  
Low Molecular Weight Heparins ◽  
Safety And Efficacy ◽  
Hip Replacements ◽  
Total Knee

Cost-effectiveness of apixaban versus other direct oral anticoagulants and low-molecular-weight-heparins for cancer associated venous thromboembolism in Spain.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18845-e18845
Author(s):  
Andres J. Muñoz Martín ◽  
Enrique Gallardo Díaz ◽  
Carlos Crespo ◽  
Roma Masana Domenech ◽  
Javier Soto ◽  
...  
Keyword(s):  
Molecular Weight ◽  
Venous Thromboembolism ◽  
Cost Effectiveness ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Relative Effectiveness ◽  
Low Molecular Weight ◽  
Low Molecular Weight Heparins ◽  
Use Of Resources ◽  
Life Years

e18845 Background: Venous thromboembolism (VTE) causes substantial morbidity and mortality in patients with cancer. The guidelines for the treatment of VTE in cancer patients recommend low molecular weight heparins (LMWH) and direct oral anticoagulants (DOAC) for patients where major bleeding is a low risk factor. Several studies show that DOAC represent a convenient and effective treatment option in alternative to LMWH in patients with deep-vein thrombosis or pulmonary embolism. Even though some recent studies have compared the effectiveness of DOAC vs LMWH, there is no available a cost-effectiveness analysis (CEA) comparing the relative effectiveness and cost-effectiveness of apixaban, other DOAC and. LMWH. The study aim was to conduct a CEA of apixaban (API), edoxaban (EDO), rivaroxaban (RIVA) and LMWH for the treatment of cancer associated VTE in Spain. Methods: We developed a Markov model with 12 transition health states. The model has been face-validated by two oncologists from two different Spanish hospitals. The use of resources and costs were obtained from the 2021 Spanish Ministry of Health database, and the main references for obtaining the outcomes were derived from CARAVAGGIO, HOKUSAI-VTE, ADAM VTE and SELECT-D trials. Our model yielded the effectiveness score in terms of cost per life-year (LY) gained and cost per quality-adjusted for life-year (QALY) gained. The time horizon was 12 months. We performed a deterministic and probabilistic sensitivity analysis to validate the robustness. Results: API showed the lowest 12-month cost (1943 €), and the highest amount of life years (0.79) and highest amount of QALY (0.55) gained. RIVA and EDO were less effective in terms of LY (0.76 and 0.74, respectively) and QALY (0.53 and 0.52, respectively) gained than LMWH (LY of 0.76 and QALY of 0.53), and less costly. The Incremental Cost-Effectiveness Ratio (ICER) scores in terms both of €/LY and €/QALY gained show that API is dominant over LMWH, RIVA and EDO. Conclusions: Our results suggest that API is more effective and more cost-effective than LMWH, RIVA or EDO with the 2021 Spanish healthcare costs. For interpretation of the results, reader must consider that the costs of resources analyzed in this paper may vary from country to country, and dabigatran was not included in the analysis since there are not cancer associated VTE clinical trials with dabigatran data to calculate CEA from.[Table: see text]

A single center retrospective cohort study comparing low-molecular-weight heparins to direct oral anticoagulants for the treatment of venous thromboembolism in patients with cancer – A real world experience

2018 ◽  
Vol 25 (4) ◽  
pp. 793-800 ◽  
Author(s):  
Megan K Phelps ◽  
Tracy E Wiczer ◽  
H Paige Erdeljac ◽  
Kelsey R Van Deusen ◽  
Kyle Porter ◽  
...  
Keyword(s):  
Molecular Weight ◽  
Major Bleeding ◽  
Oral Anticoagulant ◽  
Low Molecular Weight Heparin ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Low Molecular Weight ◽  
Direct Oral Anticoagulant ◽  
Recurrent Cancer ◽  
Cancer Associated Thrombosis

Introduction Low-molecular-weight heparins are the standard treatment for cancer-associated thrombosis. Recently, direct oral anticoagulants are a new option for thrombosis treatment; however, data supporting the use of direct oral anticoagulants for cancer-associated thrombosis are limited. Objectives The primary objective of this study was to determine the rate of recurrent cancer-associated thrombosis and major bleeding within 6 months of starting either low-molecular-weight heparin or direct oral anticoagulant for treatment of cancer-associated thrombosis. Secondary objectives were to determine the rates of clinically relevant-non-major bleeding and all-cause mortality. Patients/methods This is a retrospective cohort study including adults with cancer-associated thrombosis treated with low-molecular-weight heparin or direct oral anticoagulant between 2010 and 2016 at the Ohio State University. Medical records were reviewed for 6 months after initiation of anticoagulation or until the occurrence of recurrent cancer-associated thrombosis, major bleeding, cessation of anticoagulation of interest, or death, whichever occurred first. Results Four hundred and eighty patients were included (290 low-molecular-weight heparin and 190 direct oral anticoagulant). Patients treated with direct oral anticoagulant were found to carry “lower risk” features including cancer with lower VTE risk and lower rate of metastatic disease. After adjustment for baseline differences, there was no significant difference in the rate of recurrent cancer-associated thrombosis (7.2% low-molecular-weight heparin vs 6.3% direct oral anticoagulant, p = 0.71) or major bleeding (7.6% low-molecular-weight heparin vs 2.6% direct oral anticoagulant, p = 0.08). Conclusions Our study demonstrates that in a select population of cancer patients with VTE, direct oral anticoagulant use can be as effective and safe compared to the standard therapy with low-molecular-weight heparin.

Safety and efficacy of direct oral anticoagulants for venous thromboembolism and stroke prophylaxis in patients with hematologic malignancies

2019 ◽  
Vol 26 (2) ◽  
pp. 351-360 ◽  
Author(s):  
Stephanie Kim ◽  
Jennifer Namba ◽  
Aaron M Goodman ◽  
Thi Nguyen ◽  
Ila M Saunders
Keyword(s):  
Molecular Weight ◽  
Venous Thromboembolism ◽  
Major Bleeding ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Hematologic Malignancies ◽  
Low Molecular Weight ◽  
Direct Oral Anticoagulant ◽  
Low Molecular Weight Heparins ◽  
Bleeding Events

Purpose Low-molecular-weight heparins are currently the recommended antithrombotic therapy for treatment and prevention of malignancy-related venous thromboembolism. Currently, the evidence evaluating direct oral anticoagulants versus low-molecular-weight heparins or a vitamin K antagonist in cancer patients with hematologic malignancies is limited. We evaluated the safety and efficacy of direct oral anticoagulants for venous thromboembolism treatment or stroke prevention for non-valvular atrial fibrillation in patients with hematologic malignancies. Methods This was a retrospective evaluation of adult patients with hematologic malignancies who received at least one dose of the Food and Drug Administration-approved direct oral anticoagulant for venous thromboembolism treatment or stroke prevention. We determined the frequency of major bleeding events, non-major bleeding events, stroke, systemic embolism, appropriateness of initial direct oral anticoagulant doses, holding practices prior to procedures, and the rate of all-cause mortality. An analysis was also performed to compare the incidence of bleeding between patients with a history of hematopoietic stem cell transplant to non-transplant patients. Results A total of 103 patients were identified, with the majority of patients receiving rivaroxaban for venous thromboembolism treatment. Major bleeding events occurred in four patients and no fatal bleeding events occurred. Non-major bleeding occurred in 29 patients, most commonly epistaxis and bruising. Two patients experienced a systemic embolism while on direct oral anticoagulant therapy. Conclusion Direct oral anticoagulants may be a safe and effective alternative for anticoagulation therapy in patients with hematologic malignancies. However, larger prospective studies comparing direct oral anticoagulants to low-molecular-weight heparins or vitamin K antagonists are warranted to compare efficacy and safety outcomes in this patient population.

Cost-Effectiveness Analysis of Warfarin Versus Low-Molecular Weight Heparin for the Treatment of Malignancy-Associated Venous Thromboembolism

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 746-746 ◽  
Author(s):  
Nathan T. Connell ◽  
Gregory A. Abel ◽  
Jean M. Connors
Keyword(s):  
Molecular Weight ◽  
Sensitivity Analysis ◽  
Cost Effectiveness ◽  
Major Bleeding ◽  
Odds Ratio ◽  
Low Molecular Weight Heparin ◽  
Low Molecular Weight ◽  
The Mean ◽  
Recurrent Vte ◽  
The Cost

Introduction: Patients with active malignancy who develop venous thromboembolism (VTE) have historically been anticoagulated with a vitamin K antagonist (VKA) such as warfarin. The CLOT study (Lee et al., NEJM, 2003) demonstrated that injection with the low-molecular weight heparin (LMWH) dalteparin was better than warfarin at preventing recurrence of VTE in cancer patients, which changed clinical practice in the United States; however, a subsequent competing risks analysis (Parpia et al., Contemp Clin Trials, 2011) suggested the magnitude of this benefit may be less than previously believed. Neither patient-focused measures of utility nor the cost of each strategy have been evaluated in the current treatment era. We aimed to characterize the effectiveness and costs associated with these two management strategies for malignancy-associated VTE. Methods: We constructed a Markov state transition model to compare the cost-effectiveness of LMWH to VKA therapy for treatment of malignancy-associated thrombosis from a societal perspective. The model had 4 health states: initial anticoagulation, extended anticoagulation, no anticoagulation, and deceased. Cycle-length was 6 months with a lifetime horizon. Potential events in each cycle included recurrent VTE and death from recurrent VTE, major bleeding and death from major bleeding, minor bleeding, and death from other causes. Model inputs for event probabilities, costs, and utility were obtained from previously published literature (e.g., the ONCENOX, Main-LITE, CLOT, CANTHANOX, and CATCH trials); while no specific data exist for the utility of each strategy for treatment of malignancy-associated VTE, we assumed they would be similar to utilities previously published for non-malignant VTE, and performed sensitivity analysis to assess the robustness of our results. Microsimulation of 1000 trials was performed to calculate mean quality-adjusted life-years (QALYs) and costs associated with the two anticoagulation strategies. Results: Using a fixed effects model, the meta-analytic estimates of the odds ratio for major bleeding from LMWH as compared to VKA therapy was 0.99 (95% CI 0.65 - 1.50). The odds ratio for recurrent VTE while on LMWH as compared to VKA was 0.55 (95% CI 0.40 - 0.75) in favor of LMWH. The mean cost of the VKA strategy was $6,383.39 (±$5174.56) and for the LMWH strategy it was $64,975.83 (±$3,4743.63). The mean effectiveness of the VKA strategy was 1.19 QALYs (range 0.20 - 7.51); for the LMWH strategy it was 1.46 QALYs (range 0.20 - 9.03), resulting in a mean increase of 0.27 QALYs (Figure). The incremental cost-effectiveness ratio (ICER) was thus $221,281.83 per QALY. One-way sensitivity analysis evaluating the utility of the LMWH strategy from 0 - 1 revealed that VKA was always the preferred strategy at a willingness to pay (WTP) threshold of $100,000 per QALY. Conclusions: While LMWH is an effective treatment for malignancy-associated VTE, we found that it offers only a small gain in QALYs compared to VKAs, and that this gain is associated with a significant increase in cost. Our data suggest that LMWH is not a cost-effective strategy when applied to all patients with malignancy-associated VTE and that VKAs may be a reasonable alternative to LMWH. Figure 1. Figure 1. Disclosures No relevant conflicts of interest to declare.

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