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 knee replacement (TKR) in real-life setting, with a focus on apixaban.

METHODS:

All patients with TKR 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 60,901 patients identified, 15,720 treated with DOAC and 1,752 with apixaban (i.e. almost all DOAC patients) were matched to the same number of patients receiving LWMH. The risk of VTE was lower, but non-significantly, with DOAC than LMWH (RR: 0.69, 95%CI [0.42 to 1.16]) with less bleeding (RR: 0.64, [0.43 to 0.97]). The mean cost per patient was lower with DOAC compared to LMWH for drugs (€330 vs €439), medical visits (€204 vs €208), nursing procedures (€81 vs 264€), lab tests (€33 vs €82), hospitalisations (€316 vs €342), transports (€281 vs €353), and total medical costs (€1,492 vs €1,934). Results for apixaban vs LMWH were very similar (e.g. €1,489 vs. €1,935 for total medical costs).

CONCLUSIONS:

The study confirms a better benefit-risk ratio of DOAC compared to LMWH for thromboprophylaxis following TKR in real-life setting, associated with a 25% lower medical cost for the French collective perspective. The few patients receiving apixaban at this time provided results similar to all DOAC.