[Cost-effectiveness analysis of apixaban compared to dabigatran in the prevention of venous thromboembolism in patients subjected to total knee or hip replacement]

J F Gómez-Cerezo, I Gómez-Arrayás, C Suárez-Fernández, L Betegón-Nicolás, M de Salas-Cansado, C Rubio-Terrés
Revista Española de Cirugía Ortopédica y Traumatología 2012, 56 (6): 459-70

OBJECTIVE: Cost-effectiveness analysis of apixaban vs. dabigatran in preventing venous thromboembolism (VTE) in total knee (TKR) or hip (THR) replacement.

METHODS: Model with two periods: post-prophylaxis period of 90 days (short term) and 5 years (Markov). VTE complications (distal and proximal deep vein thrombosis, pulmonary embolism, bleeding and post-thrombotic syndrome) were included. The comparative efficacy was obtained from a meta-analysis, and the costs from Spanish sources. An annual discount rate of 3.5% for costs and benefits was applied.

RESULTS: According to the meta-analysis, the relative risk (RR) of VTE or death, compared with enoxaparin, was lower with apixaban than with dabigatran in TKR (RR 0.89, 95% CI 0.32 to 1.65 and RR 1.35, 95% CI, 0.19 to 3.39) and THR (RR 0.35, 95% CI, 0.05 to 2.51 and RR 0.89, 95% CI 0.22 to 3.21, respectively). In the short term, there were more life years (LYG) and more quality-adjusted life years (QALY) per patient in TKR (0.2037; 0.1908) and THR (0.2417; 0.1921) with apixaban than with dabigatran (0.1818; 0.1901 and 0.2345; 0.1918, respectively) were obtained. With apixaban lower costs per patient in TKR (-14 €) were generated, so it was the dominant treatment. Additional costs (15 €) could be incurred in THR, with a cost per LYG of 2,083 € and 50,000 € per QALY gained. In 5 years, apixaban was cheaper and more effective in both TKR and THR.

CONCLUSIONS: According to this study, apixaban was shown to be a cost-effective treatment compared with dabigatran for VTE prevention.

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