A value-effectiveness evaluation comparing direct oral anticoagulants (DOACs) to low-molecular-weight heparin (LMWH) found that DOACs are each more medically effective and cost-effective than LMWH when treating cancer-associated thrombosis (CAT). These findings may inform decisions on the clinical level in addition to policy decisions. The evaluation is published in Annals of Internal Medicine.

CAT is related to an almost two-fold increase in mortality compared with patients with cancer but without thrombosis. Also they are at a better risk for recurrent venous thromboembolism (VTE), which has been shown in previous research to be related to 80 percent more spent on healthcare costs. LMWH is taken into account the cornerstone of treatment for CAT, but DOACs have more recently come into clinical use.

Researchers from the UC Davis Comprehensive Cancer Center and University of Cincinnati, conducted a cost-effectiveness evaluation of 4 possible interventions for the treatment of CAT over the lifetime of a 63-year-old patient. Interventions included enoxaparin, apixaban, edoxaban, and rivaroxaban. Of their evaluation, the authors found that apixaban was the least costly anticoagulant and was more practical
than either LMWH or edoxaban. Nonetheless, rivaroxaban was barely more practical than apixaban, with an ICER of $493 246 per QALY. Nonetheless, when the costs of medicine from GoodRx were modeled, rivoroxaban became most cost-effective using contemporary threshold for societal willingness to pay. The authors note their findings demonstrated a stark difference between the real-world cost of DOACs and the drug prices from U.S. Department of Veterans Affairs Federal Supply Schedule, have implications for value-based price benchmarks in america. The authors also add that essentially the most clinically effective and cost-effective DOAC rely on a patient’s clinical characteristics, location of cancer, and unintended effects, in addition to the relative cost of every DOAC.

An accompanying editorial from authors on the Yale School of Medicine notes that while this evaluation may underestimate the cost-effectiveness of apixaban in the true world, it shines by showing the good thing about aligning drug cost with effectiveness. The authors highlight the potential for future drug-price negotiations in light of passage of the Inflation Reduction Act and note that the necessary uses of anticoagulants demonstrated on this evaluation would make the drug class contenders for value-based price benchmarks.

Source:

American College of Physicians

Journal reference:

Gulati, S., et al. (2022) Anticoagulant therapy for cancer-associated thrombosis: A value-effectiveness evaluation. Annals of Internal Medicine. doi.org/10.7326/M22-1258.