OBJECTIVES:

The aim of the study was to assess effectiveness, risk and medical costs of Direct Oral Anticoagulants (DOAC) versus Low-Molecular-Weight Heparin (LMWH) for venous thromboembolism (VTE) prevention following total hip replacement (THR) in real-life setting, with a focus on apixaban.

METHODS:

All patients with THR performed in France between 2013 Jan-1st and 2014 Sept-30^th, and home return after discharge, were identified and followed-up for 3 months in the SNIIRAM nationwide claims database. Patients treated with DOAC (dabigatran, rivaroxaban, and apixaban) were 1:1 matched on gender, age and propensity score with patients receiving LWMH. Relative risk (RR) of hospitalized VTE and bleeding during drug exposure were estimated using quasi Poisson model. Medical costs were calculated according to the collective perspective for the same period.

RESULTS:

Among the 118,724 patients identified, 31,619 treated with DOAC and 3,380 with apixaban (i.e. almost all DOAC patients) were matched to the same number of patients receiving LWMH. The risk of VTE was significantly lower with DOAC than LMWH (RR: 0.35, 95%CI [0.23 to 0.54]) without increase of bleeding (RR: 0.88, [0.62 to 1.25]). The mean cost per patient was lower with DOAC compared to LMWH for drugs (€283 vs €405), medical visits (€183 vs €199), nursing procedures (€82 vs 281€), lab tests (€29 vs €84), hospitalisations (€312 vs €401), transports (€91 vs €132), and total medical costs (€1,062 vs €1,506). Results for apixaban vs LMWH were very similar (e.g. €1060 vs. €1510 for total medical costs).

CONCLUSIONS:

The study confirms a better benefit-risk ratio of DOAC compared to LMWH for thromboprophylaxis following THR in real-life setting, associated with a 30% lower medical cost for the French collective perspective. The few patients receiving apixaban at this time provided results similar to all DOAC.