Cost-Utility Analysis Comparing Direct Oral Anticoagulant (DOAC) and Low-Molecular-Weight Heparin (LMWH) Therapies for Cancer-Associated Thrombosis (CAT) Treatment in the United States
Author(s)
Shin YE1, Hwang M2, Mackey ML2, Kumar A1, Wu WK2
1University of Cincinnati, Cincinnati, OH, USA, 2St. John's University, Queens, NY, USA
Background: Cancer patients are at high risk of developing VTE. DOACs have been shown to prevent more VTE events and cause more bleeding events than LMWHs. With the addition of DOACs in the treatment guidelines and publishing of new clinical data, an updated study evaluating the cost-effectiveness of DOACs compared to LMWHs for CAT from the United States payer and societal perspectives is needed. Objectives: Assess the cost-effectiveness of DOACs compared to LMWHs for 6- and 60-month treatment of CAT from U.S. societal and payer perspectives. Methods: A cost-utility analysis was conducted using Markov model for 65-year-old cancer patients eligible to receive rivaroxaban, edoxaban, apixaban, enoxaparin, or dalteparin. Four clinical scenarios were analyzed based on 6 and 60-month treatments from U.S. payer and societal perspectives. Transition probabilities, costs, and utilities were obtained from literature. One-way and probabilistic sensitivity analyses were performed to test the robustness of the results. The main outcome was the incremental cost-effectiveness ratio (ICER), expressed as cost in U.S. dollars per QALY. Results: ICERs from all four scenarios showed that DOACs are more cost-effective than LMWHs. For 6-month (base case) treatment from the payer perspective, DOACs dominated LMWHs and were associated with incremental cost savings of $10,626 and incremental effectiveness increase of 0.07 QALYs. In the one-way sensitivity analysis, costs of LMWHs and DOACs starting from month 2 of treatment influenced the incremental cost difference the most while the base utility values for one cycle of LMWHs and DOACs influenced the incremental effectiveness the most. Sensitivity analyses indicated that results were robust over a wide range of inputs. Conclusions: DOACs are a cost-effective alternative to LMWHs for CAT treatment. Results from this study can help inform decision-makers on anticoagulation strategies for optimal healthcare resource utilization for cancer patients and how they would benefit from anticoagulant treatment.
Conference/Value in Health Info
2022-05, ISPOR 2022, Washington, DC, USA
Value in Health, Volume 25, Issue 6, S1 (June 2022)
Code
EE504
Topic
Economic Evaluation, Study Approaches
Topic Subcategory
Cost-comparison, Effectiveness, Utility, Benefit Analysis, Decision Modeling & Simulation
Disease
Oncology