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. 2021 Oct 12;193(40):E1551-E1560.
doi: 10.1503/cmaj.210523.

Cost-utility analysis of apixaban compared with usual care for primary thromboprophylaxis in ambulatory patients with cancer

Miriam Kimpton  1 , Srishti Kumar  1 , Philip S Wells  1 , Doug Coyle  1 , Marc Carrier  1 , Kednapa Thavorn  2
Affiliations

Cost-utility analysis of apixaban compared with usual care for primary thromboprophylaxis in ambulatory patients with cancer

Miriam Kimpton et al. CMAJ. .

Abstract

Background: Apixaban (2.5 mg) taken twice daily has been shown to substantially reduce the risk of venous thromboembolism (VTE) compared with placebo for the primary thromboprophylaxis of ambulatory patients with cancer who are starting chemotherapy and are at intermediate-to-high risk of VTE. We aimed to compare the health system costs and health benefits associated with primary thromboprophylaxis using apixaban with those associated with the current standard of care (where no primary thromboprophylaxis is given), from the perspective of Canada's publicly funded health care system in this subpopulation of patients with cancer over a lifetime horizon.

Methods: We performed a cost-utility analysis to estimate the incremental cost per quality-adjusted life-year (QALY) gained with primary thromboprophylaxis using apixaban. We obtained baseline event rates and the efficacy of apixaban from the Apixaban for the Prevention of Venous Thromboembolism in High-Risk Ambulatory Cancer Patients (AVERT) trial on apixaban prophylaxis. We estimated relative risk for bleeding, risk of complications associated with VTE treatment, mortality rates, costs and utilities from other published sources.

Results: Over a lifetime horizon, apixaban resulted in lower costs to the health system (Can$7902.98 v. Can$14 875.82) and an improvement in QALYs (9.089 v. 9.006). The key driver of cost-effectiveness results was the relative risk of VTE as a result of apixaban. Results from the probabilistic analysis showed that at a willingness to pay of Can$50 000 per QALY, the strategy with the highest probability of being most cost-effective was apixaban, with a probability of 99.87%.

Interpretation: We found that apixaban is a cost-saving option for the primary thromboprophylaxis of ambulatory patients with cancer who are starting chemotherapy and are at intermediate-to-high risk of VTE.

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Conflict of interest statement

Competing interests: Marc Carrier has received consulting fees from Bayer, Sanofi, Servier, BMS, Pfizer, Leo Pharma and Valeo. Philip Wells has received personal fees in the form of payment or honoraria from the Bristol Myers Squibb (BMS)–Pfizer Alliance, Sanofi, Bayer Healthcare and Medscape. He is also the board director for the Bruyère Research Institute and Ottawa Department of Medicine Not-for-Profit Corporation. No other competing interests were declared.

Figures

Figure 1:
Figure 1:
Model structure. Note: CRNMB = clinically relevant non-major bleeding, CTEPH = chronic thromboembolic pulmonary hypertension, ICH = intracranial hemorrhage, PTS = postthrombotic syndrome, VTE = venous thromboembolism. *Patients can transition to death at any point in the model because of age-specific mortality, cancer or complications.
Figure 2:
Figure 2:
One-way sensitivity analyses. Note: CRNMB = clinically relevant non-major bleeding, CTEPH = chronic thromboembolic pulmonary hypertension, DVT = deep vein thrombosis, ICH = intracranial hemorrhage, PE = pulmonary embolism, PTS = postthrombotic syndrome, RR = relative risk, VTE = venous thromboembolism.
Figure 3:
Figure 3:
Cost-effectiveness plane for base-case analysis. Note: QALY = quality-adjusted life-year.
Figure 4:
Figure 4:
Cost-effectiveness acceptability curve for primary analysis. Note: QALY = quality-adjusted life-year, WTP = willingness to pay.
See this image and copyright information in PMC

Comment in

References

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