Cost-Effectiveness of Apixaban for Venous Thrombosis Prophylaxis in Patients with Cancer

Researchers from the Department of Medicine and the Ottawa Hospital Research Institute at the University of Ottawa in Ottawa, Ontario, led by Miriam Kimpton, MD, conducted a study to evaluate the cost-utility of apixaban for venous thromboembolism (VTE) prophylaxis compared to standard care, which does not include any primary thromboprophylaxis. Their findings, published in the Canadian Medical Association Journal, established that apixaban was a cost-saving option for VTE prophylaxis in ambulatory patients with cancer at intermediate-to-high risk of VTE who were starting chemotherapy.

The investigators evaluated the cost-utility of apixaban via incremental cost per quality-adjusted life-year (QALY) gained from primary thromboprophylaxis. Baseline data from the Apixaban for the Prevention of Venous Thromboembolism in High-Risk Ambulatory Cancer Patients (AVERT) trial were used, as well as risks for bleeding and complications from VTE treatment, mortality rate, costs, and utilities data from previously published sources.

Across a lifetime horizon, the authors found that apixaban resulted in a lower cost for the health system (Can$7902.98 vs. Can$14875.82) and an improvement in QALYs (9.089 vs. 9.0006) versus standard care with no VTE prophylaxis. According to the study’s authors, the primary contributor to the cost-effectiveness of apixaban was the relative risk of VTE. Further analysis demonstrated that a willingness to pay Can$50,000 per QALY with apixaban yielded the highest probability (99.87%) of being the most cost-effective for the health system.

The study’s authors ultimately suggested that apixaban appeared to be a cost-saving option for prophylaxis of intermediate-to-high VTE risk in ambulatory patients with cancer who were starting chemotherapy.