title: Cost-effectiveness of apixaban versus low molecular weight heparin/vitamin k antagonist for the treatment of venous thromboembolism and the prevention of recurrences.
abstract: Prior analyses beyond clinical trials are yet to evaluate the projected lifetime benefit of apixaban treatment compared to low-molecular-weight heparin (LMWH)/vitamin K antagonist (VKA) for treatment of venous thromboembolism (VTE) and prevention of recurrences. The objective of this study is to assess the cost-effectiveness of initial plus extended treatment with apixaban versus LMWH/VKA for either initial treatment only or initial plus extended treatment.
  
  
  
  A Markov cohort model was developed to evaluate the lifetime clinical and economic impact of treatment of VTE and prevention of recurrences with apixaban (starting at 10 mg BID for 1 week, then 5 mg BID for 6 months, then 2.5 mg BID for an additional 12 months) versus LMWH/VKA for 6 months and either no further treatment or extended treatment with VKA for an additional 12 months. Clinical event rates to inform the model were taken from the AMPLIFY and AMPLIFY-EXT trials and a network meta-analysis. Background mortality rates, costs, and utilities were obtained from published sources. The analysis was conducted from the perspective of the United Kingdom National Health Service. The evaluated outcomes included the number of events avoided in a 1000-patient cohort, total costs, life-years, quality-adjusted life-years (QALYs), and cost per QALY gained.
  
  
  
  Initial plus extended treatment with apixaban was superior to both treatment durations of LMWH/VKA in reducing the number of bleeding events, and was superior to initial LMWH/VKA for 6 months followed by no therapy, in reducing VTE recurrences. Apixaban treatment was cost-effective compared to 6-month treatment with LMWH/VKA at an incremental cost-effectiveness ratio (ICER) of £6692 per QALY. When initial LMWH/VKA was followed by further VKA therapy for an additional 12 months (i.e., total treatment duration of 18 months), apixaban was cost-effective at an ICER of £8528 per QALY gained. Sensitivity analysis suggested these findings were robust over a wide range of inputs and scenarios for the model.
  
  
  
  In the UK, initial plus extended treatment with apixaban for treatment of VTE and prevention of recurrences appears to be economical and a clinically effective alternative to LMWH/VKA, whether used for initial or initial plus extended treatment.
authors.affiliation: Evidera, Metro Building 6th Floor, 1 Butterwick, London, W6 8DL, UK. Tereza.lanitis@evidera.com.
authors.forename: Tereza
authors.initials: T
authors.lastname: Lanitis
authors.affiliation: Evidera, 7101 Wisconsin Avenue #1400, Bethesda, 20814, MD, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Leipold
authors.affiliation: Bristol-Myers Squibb, 100 Nassau Park Blvd, Princeton, 08540, NJ, USA.
authors.forename: Melissa
authors.initials: M
authors.lastname: Hamilton
authors.affiliation: Pfizer, 235 E 42nd St, New York, 10017, NY, USA.
authors.forename: Dale
authors.initials: D
authors.lastname: Rublee
authors.affiliation: Evidera, 7101 Wisconsin Avenue #1400, Bethesda, 20814, MD, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Quon
authors.affiliation: Evidera, Metro Building 6th Floor, 1 Butterwick, London, W6 8DL, UK.
authors.forename: Chantelle
authors.initials: C
authors.lastname: Browne
authors.affiliation: Guys and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK.
authors.forename: Alexander T
authors.initials: AT
authors.lastname: Cohen
mesh_terms: D000925:Anticoagulants / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D005260:Female; 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; D012008:Recurrence; D055502:Secondary Prevention; D013222:State Medicine / Q000191:economics; D016896:Treatment Outcome; D006113:United Kingdom; D054556:Venous Thromboembolism / Q000188:drug therapy* / Q000191:economics / Q000517:prevention & control*; D014812:Vitamin K / Q000037:antagonists & inhibitors*
chemical_list: D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D011720:Pyrazoles; D011728:Pyridones; D014812:Vitamin K; C522181:apixaban
keywords: Apixaban; Cost-effectiveness; Venous thromboembolism; Vitamin K antagonists