OBJECTIVES : The burden of venous thromboembolism (VTE) in hospitalized acute medically ill (HAMI) patients is a major concern, with over 8 million patients at risk for VTE annually in the US and over half of VTE events occurring post-discharge. Betrixaban is FDA-approved for prophylaxis of VTE in HAMI patients who are at risk for VTE. In the pivotal APEX study, orally administered betrixaban was investigated for extended-duration (35-42 days) vs standard-duration (6-14 days) VTE prophylaxis with enoxaparin. We aimed to analyze the budget impact of extended-duration, from hospital admission through post-discharge, VTE prophylaxis.

METHODS : An Excel-based model was developed to estimate the budget impact of extended-duration VTE prophylaxis. Efficacy and safety data were from the 80-mg mITT APEX sub-population. Duration of therapy was from the median APEX treatment duration (enoxaparin: 9 days; betrixaban: 36 days). Drug and clinical event costs were identified through peer-reviewed literature and extrapolated to 2017 dollars using the CPI medical inflation index. Betrixaban price was modelled at WAC ($15).

RESULTS : Assuming an institution has 20,000 acute hospitalizations per year, 3,923 patients would be non-surgical patients at ACCP-defined high VTE risk. After applying APEX study criteria, 2,458 patients would potentially be eligible to receive betrixaban. For ACOs responsible for total cost of care, drug plus administration would be $0.5M for enoxaparin and $1.4M for betrixaban. Drug acquisition cost alone would be $1.4M for betrixaban and $0.2M for enoxaparin, or an increase of $1.2M. The cost of clinical events would be $3.6M for enoxaparin vs $2.3M for betrixaban. Betrixaban would result in the avoidance of 54 VTE events. Overall, the betrixaban strategy would result in a cost savings of $0.4M, or $182 per patient treated.

CONCLUSIONS : Betrixaban as a single drug regimen for VTE prophylaxis from hospital admission through post-discharge in HAMI patients is cost-effective compared to standard-duration prophylaxis with enoxaparin.