Cost-effectiveness analysis of Apixaban versus Enoxaparin in patients undergoing total hip or knee replacement in Colombia
DOI:
https://doi.org/10.1016/j.rccot.2016.11.007Keywords:
venous thromboembolism, apixaban, hip replacement arthroplasty, knee replacement arthroplasty, cost-benefit analysisAbstract
Aim: To estimate the cost-effectiveness of apixaban versus enoxaparin to prevent venous thromboembolism (VTE) in patients undergoing total hip replacement (THR) or total knee replacement (TKR) in Colombia.
Materials & methods: Our model included a decision tree for short-term outcomes and a Markov model for long-term outcomes. Epidemiological parameters and costs were taken from a Colombian health insurance company. Medicine dose were 2.5 mg of apixaban orally twice daily or 40 mg of enoxaparin subcutaneously once daily. Clinical efficacy and safety of medicines were taken from ADVANCE-1, ADVANCE-2 and ADVANCE-3 trials. Results of economic evaluation and Life Years Gained (LYG) were measured in QALYs. Time horizon was lifetime; discount rate for costs and health outcomes was 3.5%. A univariate and probabilistic sensitivity analysis was performed for the epidemiological parameters, effectiveness of interventions and costs
Results: With apixaban, there would be 79 VTE events, 69 bleeding episodes, and 3.5 deaths. Total costs discounted were USD $ 282.50, LYG discounted were 4.56, and QALYs discounted were 3.67. With enoxaparin, there would be 134 TEV events, 81 bleeding episodes, and 6.0 deaths; total costs discounted were USD $ 394.89, LYG discounted were 4.55, and QALYs discounted were 3.66. The incremental cost-effectiveness ratio (ICER) shows that apixaban is a dominant strategy over enoxaparin. Acceptability curves show that on any willingness to pay, apixaban has a 100% chance of being chosen.
Discussion: Apixaban is a cost-saving thromboprophylaxis strategy in patients undergoing THR or TKR in Colombia, as it prevents more VTE events, bleeding, and all-cause death, generating more LYG and QALYs, and its discounted costs are lower.
Downloads
References
Dennis RJ, Rojas MX, Molina A, Roa J, Granados M, Londono˜ A, et al. Curso clínico y supervivencia en embolia pulmonar: resultados del registro multicéntrico colombiano (EMEPCO). Acta Med Colomb. 2008;33:111-6.
Motte S, Samama CM, Guay J, Barré J, Borg JY, Rosencher N. Prevention of postoperative venous thromboembolism. Risk assessment and methods of prophylaxis. Can J Anaesth. 2006;53:S68-79. https://doi.org/10.1007/BF03022254
Mohr DN, Silverstein MD, Murtaugh PA, Harrison JM. Prophylactic agents for venous thrombosis in elective hip surgery. Metaanalysis of studies using venographic assessment. Arch Intern Med. 1993;153:2221-8. https://doi.org/10.1001/archinte.1993.00410190057007
Friedman RJ. Extended thromboprophylaxis after hip or knee replacement. Orthopedics. 2003;26:S225-30. https://doi.org/10.3928/0147-7447-20030202-05
Geerts WH, Heit JA, Clagett GP, Pineo GF, Colwell CW, Anderson FA Jr, et al. Prevention of venous thromboembolism. Chest. 2001;119:S132-75. https://doi.org/10.1378/chest.119.1_suppl.132S
Davies LM, Richardson GA, Cohen AT. Economic evaluation of enoxaparin as postdischarge prophylaxis for deep vein thrombosis (DVT) in elective hip surgery. Value Health. 2000;3: 397-406. https://doi.org/10.1046/j.1524-4733.2000.36005.x
Dahl OE, Pleil AM. Investment in prolonged thromboprophylaxis with dalteparin improves clinical outcomes after hip replacement. J Thromb Haemost. 2003;1:896-906. https://doi.org/10.1046/j.1538-7836.2003.00236.x
Friedman RJ, Gallus AS, Cushner FD, Fitzgerald G, Anderson FA Jr. Global Orthopaedic Registry Investigators. Physician compliance with guidelines for deep-vein thrombosis prevention in total hip and knee arthroplasty. Curr Med Res Opin. 2008;24:87-97. https://doi.org/10.1185/030079907X242746
Rao SV, Ohman EM. Anticoagulant therapy for percutaneous coronary intervention. Circ Cardiovasc Interv. 2010;3:80-8. https://doi.org/10.1161/CIRCINTERVENTIONS.109.884478
Wong PC, Crain EJ, Xin B, Wexler RR, Lam PY, Pinto DJ, et al. Apixaban, an oral, direct and highly selective factor Xa inhibitor: in vitro, antithrombotic and antihemostatic studies. J Thromb Haemost. 2008;6:820-9. https://doi.org/10.1111/j.1538-7836.2008.02939.x
Lassen MR, Davidson BL, Gallus A, Pineo G, Ansell J, Deitchman D. The efficacy and safety of apixaban, an oral, direct factor Xa inhibitor, as thromboprophylaxis in patients following total knee replacement. J Thromb Haemost. 2007;5:2368-75. https://doi.org/10.1111/j.1538-7836.2007.02764.x
Lassen MR, Raskob GE, Gallus A, Pineo G, Chen D, Portman RJ. Apixaban or enoxaparin for thromboprophylaxis after knee replacement. N Engl J Med. 2009;361:594-604. https://doi.org/10.1056/NEJMoa0810773
Lassen MR, Raskob GE, Gallus A, Pineo G, Chen D, Hornick P. ADVANCE-2 investigators. Apixaban versus enoxaparin for thromboprophylaxis after knee replacement (ADVANCE-2): a randomized double-blind trial. Lancet. 2010;375:807-15. https://doi.org/10.1016/S0140-6736(09)62125-5
Lassen MR, Gallus A, Raskob GE, Pineo G, Chen D, Ramirez LM. ADVANCE-3 investigators. Apixaban versus enoxaparin for thromboprophylaxis after hip replacement. N Engl J Med. 2010;363:2487-98. https://doi.org/10.1056/NEJMoa1006885
Departamento Administrativo Nacional de Estadística. Proyecciones nacionales y departamentales de población 2005-2020: Estudios postcensales. Bogotá D.C.: DANE, Centro Andino de Altos Estudios CANDANE; 2010.
Kind P, Dolan P, Gudex C, Williams A. Variations in population health status: results from a United Kingdom national questionnaire survey. BMJ. 1998;316:736-41. https://doi.org/10.1136/bmj.316.7133.736
Ministerio de Hacienda y Crédito Público y Ministerio de Salud de Colombia. Decreto 2423 de 1996 por el cual se determina la nomenclatura y clasificación de los procedimientos médicos, quirúrgicos y hospitalarios del Manual Tarifario y se dictan otras disposiciones. Bogotá D.C.: Presidencia de la República de Colombia; 2012.
Salzman EW, Harris WH. Prevention of venous thromboembolism in orthopaedic patients. J Bone Joint Surg Am. 1976;58:903-13. https://doi.org/10.2106/00004623-197658070-00001
Haake DA, Berman SA. Venous thromboembolic diseases after hip surgery. Risk factors, prophylaxis and diagnosis. Clin Orthop Relat Res. 1989:212-31. https://doi.org/10.1097/00003086-198905000-00022
Li XM, Sun SG, Zhang WD. Apixaban versus enoxaparin for thromboprophylaxis after total hip or knee arthroplasty: a meta-analysis of randomized controlled trials. Chin Med J (Engl). 2012;125:2339-45.
Migliaccio-Walle K, Rublee D, Simon TA. Anticoagulation prophylaxis in orthopedic surgery: an efficiency frontier approach. Postgrad Med. 2012;124:41-9. https://doi.org/10.3810/pgm.2012.01.2516
National Institute for Health and Clinical Excellence-NHS Evidence. Apixaban for the prevention of venous thromboembolism after total hip or knee replacement in adults. Publicado: enero de 2012. [Internet] Disponible en: http://www.nice.org.uk/nicemedia/live/13648/57895/57895.pdf Consultado en enero de 2013.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Revista Colombiana de ortopedia y traumatología
This work is licensed under a Creative Commons Attribution 3.0 Unported License.
