OBJECTIVES: Venous thromboembolism (VTE) includes deep vein thrombosis (DVT) and pulmonary embolism (PE). In Hong Kong (HK), the incidence of DVT increased from 17.1 to 30.0 per 100,000 from 2000 to 2011, while that of PE increased from 3.9 to 11.7 per 100,000, leading to an increased disease burden. The non-vitamin K antagonist oral anticoagulants (NOACs) have been suggested as alternatives for treatment with fewer drug and food interactions and no requirement for routine monitoring. This study aimed to evaluate the cost-effectiveness of edoxaban versus warfarin for the treatment of adults with VTE in the HK healthcare setting.

METHODS: A Markov state-transition model with monthly cycle length was constructed to simulate clinical pathways of acute VTE patients. The model was populated with epidemiological and economic parameters to project cost-effectiveness of edoxaban over a 1-year horizon. Estimation of the risks of clinical events, including recurrent VTE, bleeding events and mortality, when receiving edoxaban or warfarin were based on a post hoc analysis of patient-level data from the Hokusai-VTE study. Cost of clinical events were HK-specific. Utilities and treatment discontinuation rates were extrapolated from literatures. All costs were 2017 figures and cost and effectiveness were both discounted at 3%.

RESULTS: Of 100,000 simulated patients, the model projected that patients treated with edoxaban had fewer number of recurrent VTE events (4,197 vs. 4,779), fewer major bleed events (1,617 vs. 1,763) and fewer clinically relevant non-major bleeding (9,721 vs. 10,804), compared to patients treated with warfarin. Total per-patient healthcare cost over one-year time horizon for edoxaban was lower than warfarin by HK$4,272 with mean QALYs gained of 0.012 per patient, suggesting endoxaban being dominant over warfarin.

CONCLUSIONS: This study showed that despite its higher drug acquisition cost, edoxaban appears to be dominant relative to warfarin for treating patients with VTE in HK.