title: Cost-effectiveness of Apixaban Versus Other Oral Anticoagulants for the Initial Treatment of Venous Thromboembolism and Prevention of Recurrence.
abstract: OBJECTIVE
  To assess the cost-effectiveness of apixaban versus rivaroxaban, low-molecular-weight heparin (LMWH)/dabigatran, and LMWH/vitamin K antagonist (VKA) for the initial treatment and prevention of recurrent thromboembolic events in patients with venous thromboembolism (VTE).
  
  
  METHODS
  A Markov model was developed to evaluate the pharmacoeconomic effect of 6 months of treatment with apixaban versus other anticoagulants over a lifetime horizon. Network meta-analyses were conducted using the results of the Apixaban after the Initial Management of Pulmonary Embolism and Deep Vein Thrombosis with First-Line Therapy (AMPLIFY), EINSTEIN-pooled, and RE-COVER I and II trials for the following end points: recurrent VTE, major bleeds, clinically relevant non-major bleeds, and treatment discontinuations. The analysis was conducted from the perspective of the United Kingdom National Health Service. The outcomes evaluated were the number of events avoided in a 1000-patient cohort, total costs, life years, quality-adjusted life years (QALYs), and cost per QALY gained over a patient's lifetime.
  
  
  RESULTS
  Treatment for 6 months with apixaban was projected to result in fewer recurrent VTE and bleeding events in comparison to rivaroxaban, LMWH/dabigatran, and LMWH/VKA. Apixaban was cost-effective compared with LMWH/VKA at an incremental cost-effectiveness ratio of £2520 per QALY gained and was a dominant (ie, lower costs and higher QALYs) alternative to either rivaroxaban or LMWH/dabigatran. Sensitivity analysis indicated that results were robust over a wide range of inputs.
  
  
  CONCLUSIONS
  The assessment of the effects and costs of apixaban in this study predicted that apixaban is a dominant alternative to rivaroxaban and LMWH/dabigatran and a cost-effective alternative to LMWH/VKA for 6 months of treatment of VTE and the prevention of recurrence.
authors.affiliation: Evidera, London, United Kingdom. Electronic address: tereza.lanitis@evidera.com.
authors.forename: Tereza
authors.initials: T
authors.lastname: Lanitis
authors.affiliation: Evidera, Bethesda, Maryland.
authors.forename: Robert
authors.initials: R
authors.lastname: Leipold
authors.affiliation: Bristol-Myers Squibb, Princeton, New Jersey.
authors.forename: Melissa
authors.initials: M
authors.lastname: Hamilton
authors.affiliation: Pfizer, New York, New York.
authors.forename: Dale
authors.initials: D
authors.lastname: Rublee
authors.affiliation: Evidera, Bethesda, Maryland.
authors.forename: Peter
authors.initials: P
authors.lastname: Quon
authors.affiliation: Evidera, London, United Kingdom.
authors.forename: Chantelle
authors.initials: C
authors.lastname: Browne
authors.affiliation: Guys and St Thomas' NHS Foundation Trust, London, United Kingdom.
authors.forename: Alexander T
authors.initials: AT
authors.lastname: Cohen
mesh_terms: D000925:Anticoagulants / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D000069604:Dabigatran / Q000191:economics* / Q000627:therapeutic use; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced; D006495:Heparin, Low-Molecular-Weight / Q000191:economics* / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D011720:Pyrazoles / Q000191:economics* / Q000627:therapeutic use; D011728:Pyridones / Q000191:economics* / Q000627:therapeutic use; D019057:Quality-Adjusted Life Years; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D000069552:Rivaroxaban / Q000191:economics* / Q000627:therapeutic use; D055502:Secondary Prevention / Q000191:economics; D006113:United Kingdom; D054556:Venous Thromboembolism / Q000188:drug therapy* / Q000517:prevention & control
chemical_list: D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D011720:Pyrazoles; D011728:Pyridones; C522181:apixaban; D000069552:Rivaroxaban; D000069604:Dabigatran
keywords: anticoagulants; apixaban; cost-effectiveness; venous thromboembolism; vitamin