Cost Effectiveness of Apixaban and Enoxaparin for the Prevention of Venous Thromboembolism After Total Knee Replacement in China

Abstract

Background and objectives: Apixaban and enoxaparin are indicated for preventing venous thromboembolism (VTE). The aim of this study was to evaluate the cost effectiveness of apixaban versus enoxaparin for the prophylaxis of VTE and associated long-term complications in Chinese patients after total knee replacement (TKR).

Methods: A decision model, which included both acute VTE (represented as a decision tree) and the long-term complications of VTE (represented as a Markov model), was developed to assess the economic outcomes of the two prophylactic strategies for Chinese patients after TKR. Transition probabilities, costs, and utilities were derived from published literature. One-way and probabilistic sensitivity analyses were performed to test the uncertainty concerning the model parameters. Quality-adjusted life-years (QALYs) and direct medical costs were reported over a 5-year horizon. Incremental cost-effectiveness ratios (ICERs) were also calculated.

Results: Thromboprophylaxis with apixaban was estimated to have a higher cost (US$68) and more health benefits (0.0006 QALYs) than thromboprophylaxis with enoxaparin over a 5.5-year time horizon, resulting in an ICER of US$108,497 per QALY gained. One-way sensitivity analyses found that the cost of apixaban and the probability of pulmonary embolism when taking either apixaban or enoxaparin had a considerable impact on the model outcomes.

Conclusions: Overall, the analysis found that the use of enoxaparin in Chinese patients after TKR was likely to be more cost effective than the use of apixaban.