title: Dalteparin or vitamin K antagonists to prevent recurrent venous thromboembolism in cancer patients: a patient-level economic analysis for France and Austria.
abstract: International guidelines recommend extended duration secondary prophylaxis in cancer patients who develop primary venous thromboembolism (VTE). Agent selection is guided in part by one large randomized trial (i.e., CLOT; Lee et al., N Engl J Med 349:146-53, 2003) which demonstrated that dalteparin reduced the relative risk of recurrence by 52% compared with oral vitamin K antagonists (VKA; HR = 0.48, 95% CI, 0.30 to 0.77). In a subgroup analysis from that same trial, patients with renal impairment also derived benefit with dalteparin (VTE rates = 3% vs. 17%; p = 0.011). To measure the economic value of secondary VTE prophylaxis with dalteparin, a patient-level pharmacoeconomic analysis was conducted from the Austrian and French healthcare system perspectives.
  
  
  
  Chapter 1 Healthcare resource use collected during the CLOT trial was extracted and converted into direct cost estimates. Incremental cost differences between the dalteparin and VKA groups were then combined with health state utilities to measure the cost per quality-adjusted life year (QALY) gained.
  
  
  
  The dalteparin group had significantly higher costs than the VKA group in both countries (Austria: dalteparin = €2687 vs. VKA = €2012; France: dalteparin = €2053 vs. VKA = €1352: p < 0.001). However, when the incremental costs were combined with the utility gain, dalteparin had a cost of €6600 and €4900 per QALY gained in Austria and France, respectively. The analyses in patients with renal impairment suggested an even better economic profile, with the cost per QALY gained being less than €4000 in both countries.
  
  
  
  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, 283 Danforth Ave, Suite 448 M4K 1N2, Toronto, Canada. george@augmentium.com.
authors.forename: George
authors.identifier: 0000-0002-1637-3122
authors.initials: G
authors.lastname: Dranitsaris
authors.affiliation: Pfizer Inc, New York, NY, USA.
authors.forename: Lesley G
authors.initials: LG
authors.lastname: Shane
authors.affiliation: Montpellier University Hospital, Montpellier, France.
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Galanaud
authors.affiliation: Vienna General Hospital, Vienna, Austria.
authors.forename: Gunar
authors.initials: G
authors.lastname: Stemer
authors.affiliation: Institut Sainte Catherine, Avignon, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Debourdeau
authors.affiliation: Pfizer Inc, New York, NY, USA.
authors.forename: Seth
authors.initials: S
authors.lastname: Woodruff
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use*; D001317:Austria; D003362:Cost-Benefit Analysis; D017985:Dalteparin / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D005260:Female; D005602:France; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications* / Q000188:drug therapy; D011788:Quality of Life / Q000523:psychology*; D012008:Recurrence; D054556:Venous Thromboembolism / Q000191:economics* / Q000517:prevention & control*; D014812:Vitamin K / Q000037:antagonists & inhibitors*
chemical_list: D000925:Anticoagulants; D014812:Vitamin K; D017985:Dalteparin
keywords: Cancer; Dalteparin; Low molecular weight heparin; Recurrence; Venous thromboembolism; Vitamin K antagonists