OBJECTIVES: This study aimed to determine the cost-effectiveness of Edoxaban versus low-molecular-weight heparin (LMWH) /vitamin K antagonist (VKA) from the US healthcare system perspective.

METHODS: A markov state-transition model was developed to evaluate the cost and quality adjusted life years(QALY) for treatment of Venous Thromboembolism(VTE) with Edoxaban and LMWH/VKA for 10 cycles of 3 months each. Clinical event rates and utilities of Edoxaban and LMWH/VKA treatments were modelled using the Hokusai-VTE trial, AMPLIFY and AMPLIFY-EXT trials respectively. The outcomes of this simulation were: recurrent deep-vein thrombosis(DVT), recurrent pulmonary embolism (PE), intracranial hemorrhage(ICH) major bleed, Non-ICH major bleed, clinically relevant nonmajor bleeding(CRNM) and treatment discontinuations. All costs were derived from real-world databases and published sources. The drug acquisition cost was currently derived (2018) and were as follows: Edoxaban -$13.47, LMWH -$23.86 and VKA- $0.58 per day.

RESULTS: Edoxaban therapy for up to 30 months was associated with $378.2 per patient higher total health care costs and a 0.015 QALY increase versus LMWH/VKA. Edoxaban was found to be cost-effective compared with LMWH/VKA at an incremental cost-effectiveness ratio (ICER) of $25,213 per QALY gained, well below the high economic value threshold of $50,000 per QALY gained. One-way sensitivity analyses found that the cost of Edoxaban and the probability of recurrent deep-vein thrombosis as well as recurrent pulmonary embolism when taking either Edoxaban or LMWH/VKA had a considerable impact on the model outcomes. Varying Edoxaban daily cost by ±20% resulted in ICERs ranging from $16,674.3 to $31,194.3/QALY.

CONCLUSIONS: Based on current analysis, the assessment of costs and effectiveness of Edoxaban and LMWH/VKA found that despite the higher drug acquisition cost Edoxaban, it is a cost-effective alternative to LMWH/VKA for 30 months of treatment of Venous Thromboembolism.