title: Economic Analysis Comparing Dalteparin to Vitamin K Antagonists to Prevent Recurrent Venous Thromboembolism in Patients With Cancer Having Renal Impairment.
abstract: BACKGROUND
  In a randomized trial (ie, Comparison of Low-Molecular-Weight Heparin versus Oral Anticoagulant Therapy for the Prevention of Recurrent Venous Thromboembolism in Patients with Cancer [CLOT]) that evaluated secondary prophylaxis of recurrent venous thromboembolism (VTE) in patients with cancer, dalteparin reduced the relative risk by 52% compared to oral vitamin K antagonists (VKAs; hazard ratio = 0.48, P = .002). A recent subgroup analysis in patients with moderate to severe renal impairment also revealed lower absolute VTE rates with dalteparin (3% vs 17%; P = .011). To measure the economic value of dalteparin in these populations, a pharmacoeconomic analysis was conducted from the Dutch health-care system perspective.
  
  
  METHODS
  Resource utilization data contained within the CLOT trial database were extracted and converted into direct cost estimates. Univariate analysis was then conducted to compare the total cost of therapy between patients randomized to dalteparin or VKA therapy. Health state utilities were then measured in 24 members of the general public using the time trade-off technique.
  
  
  RESULTS
  When all of the cost components were combined for the entire population (n = 676), the dalteparin group had significantly higher overall costs than the VKA control group (dalteparin = €2375 vs VKA = €1724; P < .001). However, dalteparin was associated with a gain of 0.14 (95% confidence interval [CI]: 0.10-0.18) quality-adjusted life years (QALYs) over VKA. When the incremental cost was combined with the utility gain, dalteparin had a cost of €4,697 (95% CI: €3824-€4951) per QALY gained.
  
  
  CONCLUSIONS
  Secondary prophylaxis with dalteparin is a cost-effective alternative to VKA for the prevention of recurrent VTE in patients with cancer.
authors.affiliation: Augmentium Pharma Consulting Inc, Toronto, Ontario, Canada george@augmentium.com.
authors.forename: George
authors.initials: G
authors.lastname: Dranitsaris
authors.affiliation: Pfizer Inc, New York, NY, USA.
authors.forename: Lesley
authors.initials: L
authors.lastname: Shane
authors.affiliation: Pfizer Netherlands, Rivium Westlaan, the Netherlands.
authors.forename: Laura
authors.initials: L
authors.lastname: Burgers
authors.affiliation: Pfizer Inc, New York, NY, USA.
authors.forename: Seth
authors.initials: S
authors.lastname: Woodruff
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D017985:Dalteparin / Q000009:adverse effects / Q000191:economics*; D005260:Female; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D051437:Renal Insufficiency / Q000188:drug therapy / Q000191:economics*; D054556:Venous Thromboembolism / Q000517:prevention & control*; D014812:Vitamin K / Q000037:antagonists & inhibitors*; D055815:Young Adult
chemical_list: D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D014812:Vitamin K; D017985:Dalteparin
keywords: cancer; cost effectiveness; dalteparin; low-molecular-weight heparin; recurrence; venous thromboembolism