Medical Oncology Department, Instituto de Investigación Sanitaria Gregorio Marañon, Universidad Complutense, Madrid, Spain.
Oncology Department, Parc Taulí Hospital Universitari, Institut d'Investigació I Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Spain.
J Med Econ. 2022 Jan-Dec;25(1):840-847. doi: 10.1080/13696998.2022.2087998.
Recent studies have compared the efficacy and safety of direct-acting oral anticoagulants (DOAC) and low-molecular-weight heparin (LMWH) for cancer-associated venous thromboembolism (VTE). However, there is no available cost-effectiveness analysis comparing DOAC and LMWH. The study aimed to conduct a cost-effectiveness analysis of DOAC (apixaban, edoxaban, and rivaroxaban) LMWH for the treatment of cancer-associated VTE in Spain from the Spanish healthcare system perspective.
We developed a Markov model with a 12-month time horizon. The states included pulmonary embolism, deep vein thrombosis, major and non-major bleeding, chronic thromboembolic pulmonary hypertension, post-thrombotic syndrome, and death. The use of medical resources and drug costs were obtained from the 2021 Spanish Ministry of Health database, and the main references for obtaining the outcomes were derived from Caravaggio, Hokusai VTE Cancer, ADAM VTE, and SELECT-D trials. We performed a deterministic and probabilistic sensitivity analysis to validate the robustness. The Incremental Cost-Effectiveness Ratio (ICER) scores cost per life-year (€/LY) gained and cost per quality-adjusted life-year (€/QALY) gained.
The 12-month cost of DOAC was 1,994€ (apixaban 1,944€, edoxaban 1,968€, rivaroxaban 2,122€) and 2,152€ for LMWH. The amount of QALY for DOAC was 0.54 (apixaban 0.55, rivaroxaban 0.53, and edoxaban 0.52) and 0.53 for LMWH. We observed similar results for LYs. ICER scores in terms both of €/LY and €/QALY show that DOAC is dominant over LMWH and apixaban showed the best profile.
Our research is based on an indirect comparison of a short-term clinical trial.
Our results suggest that DOAC is cost-effective and cost-saving compared to LMWH in treating VTE.
最近的研究比较了直接作用的口服抗凝剂（DOAC）和低分子肝素（LMWH）在癌症相关静脉血栓栓塞症（VTE）中的疗效和安全性。然而，目前尚无比较 DOAC 和 LMWH 的成本效益分析。本研究旨在从西班牙医疗保健系统的角度，对 DOAC（阿哌沙班、依度沙班和利伐沙班）与 LMWH 治疗西班牙癌症相关 VTE 的成本效益进行分析。
我们建立了一个 12 个月时间跨度的 Markov 模型。状态包括肺栓塞、深静脉血栓形成、大出血和非大出血、慢性血栓栓塞性肺动脉高压、血栓后综合征和死亡。医疗资源的使用和药物成本来自 2021 年西班牙卫生部数据库，主要的结果来源于 Caravaggio、Hokusai VTE Cancer、ADAM VTE 和 SELECT-D 试验。我们进行了确定性和概率敏感性分析以验证稳健性。增量成本效益比（ICER）评分以每获得 1 个生命年（€/LY）的成本和每获得 1 个质量调整生命年（€/QALY）的成本来表示。
DOAC 的 12 个月成本为 1994€（阿哌沙班 1944€，依度沙班 1968€，利伐沙班 2122€），LMWH 的成本为 2152€。DOAC 的 QALY 为 0.54（阿哌沙班 0.55，利伐沙班 0.53，依度沙班 0.52），LMWH 的为 0.53。LY 也有类似的结果。无论是从€/LY 还是从€/QALY 的角度来看，ICER 评分均表明 DOAC 优于 LMWH，而阿哌沙班的效果最佳。
我们的研究基于短期临床试验的间接比较。
我们的结果表明，与 LMWH 相比，DOAC 在治疗 VTE 方面具有成本效益，并且具有成本节约效果。
