title: [Cost-effectiveness analysis of apixaban compared to dabigatran in the prevention of venous thromboembolism in patients subjected to total knee or hip replacement].
abstract: OBJECTIVE
  Cost-effectiveness analysis of apixaban vs. dabigatran in preventing venous thromboembolism (VTE) in total knee (TKR) or hip (THR) replacement.
  
  
  METHODS
  Model with two periods: post-prophylaxis period of 90 days (short term) and 5 years (Markov). VTE complications (distal and proximal deep vein thrombosis, pulmonary embolism, bleeding and post-thrombotic syndrome) were included. The comparative efficacy was obtained from a meta-analysis, and the costs from Spanish sources. An annual discount rate of 3.5% for costs and benefits was applied.
  
  
  RESULTS
  According to the meta-analysis, the relative risk (RR) of VTE or death, compared with enoxaparin, was lower with apixaban than with dabigatran in TKR (RR 0.89, 95% CI 0.32 to 1.65 and RR 1.35, 95% CI, 0.19 to 3.39) and THR (RR 0.35, 95% CI, 0.05 to 2.51 and RR 0.89, 95% CI 0.22 to 3.21, respectively). In the short term, there were more life years (LYG) and more quality-adjusted life years (QALY) per patient in TKR (0.2037; 0.1908) and THR (0.2417; 0.1921) with apixaban than with dabigatran (0.1818; 0.1901 and 0.2345; 0.1918, respectively) were obtained. With apixaban lower costs per patient in TKR (-14 €) were generated, so it was the dominant treatment. Additional costs (15 €) could be incurred in THR, with a cost per LYG of 2,083 € and 50,000 € per QALY gained. In 5 years, apixaban was cheaper and more effective in both TKR and THR.
  
  
  CONCLUSIONS
  According to this study, apixaban was shown to be a cost-effective treatment compared with dabigatran for VTE prevention.
authors.affiliation: Servicio de Medicina Interna, Hospital Universitario Infanta Sofía, Madrid, España.
authors.forename: J F
authors.initials: JF
authors.lastname: Gómez-Cerezo
authors.forename: I
authors.initials: I
authors.lastname: Gómez-Arrayás
authors.forename: C
authors.initials: C
authors.lastname: Suárez-Fernández
authors.forename: L
authors.initials: L
authors.lastname: Betegón-Nicolás
authors.forename: M
authors.initials: M
authors.lastname: de Salas-Cansado
authors.forename: C
authors.initials: C
authors.lastname: Rubio-Terrés
mesh_terms: D000925:Anticoagulants / Q000191:economics* / Q000627:therapeutic use; D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D001562:Benzimidazoles / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D000069604:Dabigatran; D017721:Hospital Costs / Q000706:statistics & numerical data; D006801:Humans; D008390:Markov Chains; D018803:Models, Economic; D011183:Postoperative Complications / Q000191:economics / Q000401:mortality / Q000517:prevention & control*; D011655:Pulmonary Embolism / Q000191:economics / Q000209:etiology / Q000401:mortality / Q000517:prevention & control; D011720:Pyrazoles / Q000191:economics* / Q000627:therapeutic use; D011728:Pyridones / Q000191:economics* / Q000627:therapeutic use; D013030:Spain; D016896:Treatment Outcome; D054556:Venous Thromboembolism / Q000191:economics / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D020246:Venous Thrombosis / Q000191:economics / Q000209:etiology / Q000401:mortality / Q000517:prevention & control; D015091:beta-Alanine / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D001562:Benzimidazoles; D011720:Pyrazoles; D011728:Pyridones; D015091:beta-Alanine; C522181:apixaban; D000069604:Dabigatran