OBJECTIVES:

Dutch guidelines advise lifelong anticoagulant treatment with direct oral anticoagulants (DOACs) or vitamin K antagonists (VKAs) for patients with idiopathic venous thromboembolism (VTE) who do not have high bleeding risk.

The aim of this study was to analyze the economic effects of lifelong treatment of apixaban in the Netherlands, based on updated and adapted previous modelling exercises for use of apixaban in acute VTE-patients.

METHODS:

We performed a cost-effectiveness analysis (CEA) simulating a population of 1,000 VTE patients. Two different CEAs were explored: lifelong apixaban treatment vs. no treatment after the first 6 months (base case analysis). In scenario analysis, the initial treatment period of 6 months with apixaban versus LMWH/VKA was also included. The primary outcome of the model is the incremental cost-effectiveness ratio (ICER) in costs (€) per quality adjusted life-year (QALY), with one QALY defined as one year in perfect health. To account for any influence of the uncertainties in the model a probabilistic sensitivity analysis (PSA) was conducted, in which the ICER was recalculated 2,000 times while varying all input parameters over their range. These results were summarized in a cost-effectiveness acceptability curve (CEAC). The treatment was considered cost-effective with an ICER less than €20,000/QALY, which is the most commonly used willingness-to-pay (WTP) threshold for preventive drugs in the Netherlands and potentially indicative for other European countries as well.

RESULTS:

The model showed a reduction in recurrent-VTE and no increase in major bleeding events for lifelong treatment. Deterministic results showed ICERs of €9,830/QALY and €8,231/QALY in the base case and scenario analysis, respectively. The probabilities of being cost-effective at a WTP threshold of €20,000/QALY were 70.4% and 79.5%, respectively.

CONCLUSIONS: Lifelong treatment with apixaban is cost-effective for the prevention of recurrent VTE in Dutch VTE patients.