A decision model to estimate a risk threshold for venous thromboembolism prophylaxis in hospitalized medical patients

Le, Phuc; Martinez, Kathryn A.; Pappas, Matthew A.; Rothberg, Michael B.

doi:10.1111/jth.13687

Cited by 20 publications

(25 citation statements)

References 55 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Two studies investigated the costeffectiveness of VTE prophylaxis with enoxaparin, UFH, and no prophylaxis in hospitalized medical patients [33,34]. One study compared the cost-effectiveness of LMWH against no prophylaxis [37], one compared enoxaparin with no prophylaxis [36], one compared enoxaparin with UFH [35], and one compared dalteparin with UFH [58]. Another study compared ultrasound screening with a DVT prevention program in patients receiving LMWH [38].…”

Section: Discussionmentioning

confidence: 99%

“…Another study compared ultrasound screening with a DVT prevention program in patients receiving LMWH [38]. Four of the studies [33][34][35]58] used a payer perspective, and six studies used a decision tree, a Markov model, or a combination of both to evaluate cost-effectiveness [33][34][35][36][37][38]. Of the studies incorporating a Markov model, two studies used a lifetime horizon and a discount rate of 3% per annum [37,38] and the other used a 2-year time horizon (discount rate not reported) [34].…”

Section: Discussionmentioning

confidence: 99%

“…As none of the previous cost-effectiveness studies involved betrixaban, no direct comparison between results can be made. However, one study identified that dalteparin Six studies did not report or determine total QALYs gained for patients receiving enoxaparin or other LMWH [33][34][35][36][37]58]. One study estimated critically ill patients receiving an unspecified LMWH accrued 5.93 QALYs, compared with 3.22 reported herein [38].…”

Section: Discussionmentioning

confidence: 99%

“…A decision analytic model was constructed with a decisiontree component (evaluating short-term costs and outcomes of prophylaxis) followed by a Markov model component (evaluating long-term costs and outcomes post-prophylaxis). This structure aligns with several published US-perspective VTE prophylaxis cost-effectiveness studies, whose model structures consist of a decision tree, Markov model, or combination of both [33][34][35][36][37][38]. Model health states were selected to capture events that impact VTE at-risk patients requiring prophylaxis, based on events captured in previous studies and outcomes observed in the APEX study [30].…”

Section: Model Structurementioning

confidence: 99%

“…The model structure was based on approaches used in previous US cost-effectiveness studies investigating VTE prophylaxis identified by the SLR [33][34][35][36][37][38]. Clinical data within the model were informed by APEX trial data and SLR-identified published literature.…”

Section: Validationmentioning

confidence: 99%

See 4 more Smart Citations

Cost-Effectiveness of Betrixaban Compared with Enoxaparin for Venous Thromboembolism Prophylaxis in Nonsurgical Patients with Acute Medical Illness in the United States

Guy¹,

Laskier²,

Fisher³

et al. 2018

PharmacoEconomics

View full text Add to dashboard Cite

Background Studies show that the risk of venous thromboembolism (VTE) continues post-discharge in nonsurgical patients with acute medical illness. Betrixaban is the first anticoagulant approved in the United States (US) for VTE prophylaxis extending beyond hospitalization. Objective The aim was to establish whether betrixaban for VTE prophylaxis in nonsurgical patients with acute medical illness at risk of VTE in the US is cost-effective compared with enoxaparin. Methods A cost-effectiveness analysis was conducted, estimating the cost per quality-adjusted life-year (QALY) gained with betrixaban (35-42 days) compared with enoxaparin (6-14 days) from a US payer perspective over a lifetime horizon. A decision tree (DT) estimated primary VTE events, thrombotic events, and treatment complications in the first 3 months based on data from the phase III Acute Medically Ill VTE Prevention with Extended Duration Betrixaban study. A Markov model estimated recurrent events and long-term complication risks from published literature. EuroQoL-5 Dimensions utility data and costs inflated to 2017 US dollars (US$) were from published literature. Results were discounted at 3.0% per annum. Deterministic and probabilistic sensitivity analyses explored uncertainty. Results Betrixaban dominated enoxaparin, with savings of US$784 and increased QALYs of 0.017 per patient. In addition, betrixaban dominated enoxaparin across all sensitivity analyses, but was most sensitive to utilities and DT probabilities. Furthermore, probabilistic sensitivity analysis found that betrixaban was more cost-effective than enoxaparin at all willingness-to-pay thresholds. Conclusion Betrixaban can be considered cost-effective for nonsurgical patients with acute medical illness at risk of VTE, requiring longer VTE prophylaxis from hospitalization through post-discharge. Key Points for Decision MakersProphylaxis of venous thromboembolism (VTE) from hospitalization through post-discharge is a new option for acute medically ill patients at high risk of thromboembolic events.In the US, a 35-42-day regimen with betrixaban, from hospitalization through post-hospital-discharge, was found to accrue more quality-adjusted life-years (QALYs) and less costs compared with a 6-14-day prophylaxis with enoxaparin, due to a reduced incidence of thromboembolic events and lower associated costs, for nonsurgical patients with acute medical illness at risk of VTE.Betrixaban dominated enoxaparin, with 0.017 additional QALYs accrued and cost savings of US$784 per patient.Electronic supplementary material The online version of this article (https ://doi.

show abstract