title: Cost-effectiveness Analysis for Apixaban in the Acute Treatment and Prevention of Venous Thromboembolism in the Netherlands.
abstract: Low-molecular weight heparin (LMWH) followed by vitamin K antagonists (VKAs) are the current standard treatment of acute venous thromboembolism (VTE) and prevention of recurrent VTE. The direct oral anticoagulant apixaban was recently found noninferior in efficacy and superior in preventing major bleeding compared with LMWH/VKAs in the AMPLIFY (Apixaban for the Initial Management of Pulmonary Embolism and Deep-Vein Thrombosis as First-Line Therapy) trial. The objective of this study was to calculate the cost-effectiveness of apixaban compared with LMWH/VKA in the treatment of acute VTE and prevention of recurrent VTE in the Netherlands.
  
  
  
  A Markov model was designed to simulate a cohort of 1,000 VTE patients receiving either apixaban or LMWH/VKA. Transition probabilities, costs, and utilities were obtained from the AMPLIFY trial and other literature. The incremental cost-effectiveness ratio (ICER) was calculated from the societal perspective; therefore, the model included both direct (inside and outside the health care sector) and indirect costs. In the univariate and probabilistic sensitivity analyses (PSAs) the robustness of the results was tested, and various additional scenario analyses were conducted.
  
  
  
  In the base-case analysis, apixaban saved €236 and 0.044 quality-adjusted life years (QALYs) and 0.039 LYs were gained compared with LMWH/VKA. In the univariate sensitivity analysis the model appeared to be robust. The results of 2,000 iterations in the PSA found that the probability of apixaban being cost-effective at a willingness-to-pay threshold of €20,000/QALY was 100% and cost-saving was 94%. The scenario of 18-month treatment duration was the only scenario not indicating cost-savings with an ICER of €425/QALY.
  
  
  
  In acute anticoagulation use apixaban was found to be cost-saving. A longer anticoagulation period (18 months) resulted in a higher difference in drug costs, indicating a higher ICER. The cost-effectiveness of long-term or life-long use should be examined in future research.
authors.affiliation: Unit of PharmcoEpidemiology and PharmacoEconomics (PE2), University of Groningen, Groningen, the Netherlands. Electronic address: l.a.de.jong@student.rug.nl.
authors.forename: Lisa A
authors.initials: LA
authors.lastname: de Jong
authors.affiliation: Unit of PharmcoEpidemiology and PharmacoEconomics (PE2), University of Groningen, Groningen, the Netherlands.
authors.forename: Evgeni
authors.initials: E
authors.lastname: Dvortsin
authors.affiliation: Bristol-Myers Squibb, Utrecht, the Netherlands.
authors.forename: Kristel J
authors.initials: KJ
authors.lastname: Janssen
authors.affiliation: Unit of PharmcoEpidemiology and PharmacoEconomics (PE2), University of Groningen, Groningen, the Netherlands; Institute for Science in Healthy Aging & healthcaRE (SHARE), University Medical Center Groningen (UMCG), Groningen, the Netherlands.
authors.forename: Maarten J
authors.initials: MJ
authors.lastname: Postma
mesh_terms: D000925:Anticoagulants / Q000191:economics / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006495:Heparin, Low-Molecular-Weight / Q000191:economics / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D011720:Pyrazoles / Q000191:economics / Q000627:therapeutic use*; D011728:Pyridones / Q000191:economics / Q000627:therapeutic use*; D019057:Quality-Adjusted Life Years; D054556:Venous Thromboembolism / Q000188:drug therapy*
chemical_list: D000925:Anticoagulants; D005343:Fibrinolytic Agents; D006495:Heparin, Low-Molecular-Weight; D011720:Pyrazoles; D011728:Pyridones; C522181:apixaban
keywords: apixaban; cost-effectiveness; direct oral anticoagulant; venous thromboembolism