OBJECTIVES: To evaluate the cost-effectiveness of apixaban 2.5 mg twice a day compared with a daily dose of enoxaparin 40 mg, dabigatran 220 mg and rivaroxaban 10 mg as venous thromboembolic events preventive therapy in patients after a total hip replacement (THR) or total knee replacement (TKR) surgery in Colombia.

METHODS: A decision-tree was used to model acute events until 90 days after surgery followed by a lifetime Markov model capturing VTE events, bleedings, long-term complications of VTE and recurrent VTE events. It was populated with data (transition probabilities, duration of treatment, and quality-adjusted life years) derived from international published sources. The drug costs were obtained from 2017 SISMED report. Resource used was estimated by an expert and cost inputs were from standard Colombian tariff manuals. The used exchanged rate was COP$ 2.957 per USD$ 1. The analysis was conducted from the government-payer perspective over 5 year time horizon. Probabilistic sensitivity analysis was conducted.

RESULTS: In the base case analysis, apixaban was estimated to be a dominant strategy compared with enoxaparin and dabigatran. Compared with rivaroxaban, it generated slightly lower QALYs and lower costs with an ICER of USD$ 17.034. There were fewer bleeding events with apixaban therapy compared with all comparators, and VTEs, recurrent VTEs, and post-thrombotic syndrome events were fewer with rivaroxaban. The probabilistic sensitivity analyses showed that apixaban was more likely to be cost-effective than enoxaparin, dabigatran and rivaroxaban for the willingness to pay (WTP) thresholds less than USD$ 31.000. At a WTP threshold of 1 GDP per capita, likelihood to be cost effective was 97% for apixaban; 3% for rivaroxaban.

CONCLUSIONS: Apixaban was found to be a cost-effective treatment compared with enoxaparin and dabigatran for VTE prevention after TKR and THR and have higher likelihood to be cost effective.