Extended Treatment with Apixaban for Venous Thromboembolism Prevention in the Netherlands: Clinical and Economic Effects

Abstract

Background Dutch guidelines advise extended anticoagulant treatment with direct oral anticoagulants or vitamin K antagonists for patients with idiopathic venous thromboembolism (VTE) who do not have high bleeding risk. Objectives The aim of this study was to analyze the economic effects of extended treatment of apixaban in the Netherlands, based on an updated and adapted previously published model. Methods We performed a cost-effectiveness analysis simulating a population of 1,000 VTE patients. The base-case analysis compared extended apixaban treatment to no treatment after the first 6 months. Five additional scenarios were conducted to evaluate the effect of different bleeding risks and health care payers' perspective. The primary outcome of the model is the incremental cost-effectiveness ratio (ICER) in costs (€) per quality-adjusted life-year (QALY), with one QALY defined as 1 year in perfect health. To account for any influence of the uncertainties in the model, probabilistic and univariate sensitivity analyses were conducted. The treatment was considered cost-effective with an ICER less than €20,000/QALY, which is the most commonly used willingness-to-pay (WTP) threshold for preventive drugs in the Netherlands. Results The model showed a reduction in recurrent VTE and no increase in major bleeding events for extended treatment in all scenarios. The base-case analysis showed an ICER of €9,653/QALY. The probability of being cost-effective for apixaban in the base-case was 70.0% and 91.4% at a WTP threshold of €20,000/QALY and €50,000/QALY, respectively. Conclusion Extended treatment with apixaban is cost-effective for the prevention of recurrent VTE in Dutch patients.

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“…For example, the UK has an ICER threshold of 20,000-30,000 GBP per QALY 20 . In the Netherlands, a threshold of 20,000 EUR per QALY is commonly used 21 , and in the Unites States, the threshold is around 50,000-100,000 USD per QALY 22 . Likewise, in Japan, cost-effectiveness analysis has been emphasized recently for policy decision-making.…”

Successful Treatment of Recurrent Thrombosis Associated with Malignancy with Apixaban and Follow-up for 1 Year

“…22 In a simulation carried out in the Netherlands, apixaban was also found to reduce recurrent VTE with no increase in bleeding rates. 23 The cost effectiveness of apixaban treatment was also analyzed and it was found that there was an incremental cost-effectiveness ratio (ICER) of €9,653 per quality-adjusted life-year (QALY). The probability of being cost-effective for apixaban in the basecase was 70.0 and 91.4% at a WTP (willingness to pay) threshold of €20,000/QALY and €50,000/QALY, respectively.…”