title: Cost-effectiveness of edoxaban for the treatment of venous thromboembolism based on the Hokusai-VTE study.
abstract: OBJECTIVE
  Venous thromboembolism (VTE) is associated with almost 300,000 deaths per year in the United States. Novel oral anticoagulants (NOACs) offer an alternative to warfarin-based therapy without monitoring requirements and with fewer drug and food interactions. Edoxaban, a direct Xa inhibitor, is approved by the Food and Drug Administration (FDA), based upon results of the Hokusai-VTE Phase 3 trial. The trial demonstrated that edoxaban administered once daily after initial treatment with heparin was non-inferior in reducing the risk of VTE recurrence and caused significantly less major and clinically relevant non-major (CRNM) bleeding compared to warfarin. The objective of this study was to evaluate the cost-effectiveness of edoxaban versus warfarin for the treatment of adults with VTE.
  
  
  METHODS
  A cost-effectiveness model was developed using patient-level data from the Hokusai-VTE trial, clinical event costs from real-world databases, and drug acquisition costs for warfarin of $0.36 and edoxaban of $9.24 per tablet.
  
  
  RESULTS
  From a U.S. health-care delivery system perspective, the incremental cost-effectiveness ratio (ICER) was $22,057 per quality adjusted life year (QALY) gained. Probabilistic sensitivity analysis showed that edoxaban had an ICER <$50,000 per QALY gained relative to warfarin in 67% of model simulations. The result was robust to variation in key model parameters including the cost and disutility of warfarin monitoring.
  
  
  CONCLUSIONS
  Despite its higher drug acquisition cost, edoxaban is a cost-effective alternative to warfarin for the treatment of VTE.
authors.affiliation: a Health Economics and Outcomes Research, Daiichi Sankyo, Inc ., Parsippany , NJ , USA.
authors.forename: Ronald
authors.initials: R
authors.lastname: Preblick
authors.affiliation: a Health Economics and Outcomes Research, Daiichi Sankyo, Inc ., Parsippany , NJ , USA.
authors.forename: W Jacqueline
authors.initials: WJ
authors.lastname: Kwong
authors.affiliation: b Division of General Medicine, Anticoagulation Service , University of California Davis Health System , Sacramento , CA , USA.
authors.forename: Richard H
authors.initials: RH
authors.lastname: White
authors.affiliation: c Cardiovascular Division , Brigham and Women's Hospital , Boston , MA , USA.
authors.forename: Samuel Z
authors.initials: SZ
authors.lastname: Goldhaber
mesh_terms: D000328:Adult; D000925:Anticoagulants / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D065427:Factor Xa Inhibitors / Q000191:economics* / Q000627:therapeutic use; D005260:Female; D006470:Hemorrhage / Q000517:prevention & control; D006801:Humans; D008297:Male; D008875:Middle Aged; D011725:Pyridines / Q000191:economics* / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D013844:Thiazoles / Q000191:economics* / Q000627:therapeutic use; D016896:Treatment Outcome; D054556:Venous Thromboembolism / Q000188:drug therapy* / Q000191:economics*; D014859:Warfarin / Q000191:economics
chemical_list: D000925:Anticoagulants; D065427:Factor Xa Inhibitors; D011725:Pyridines; D013844:Thiazoles; D014859:Warfarin; C552171:edoxaban
keywords: Cost effectiveness; Edoxaban; Novel oral anticoagulants; Venous thromboembolism; Warfarin