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

Holly Guy (), Vicki Laskier, Mark Fisher, W. Richey Neuman, Iwona Bucior, Steven Deitelzweig and Alexander T. Cohen
Additional contact information
Holly Guy: FIECON Ltd
Vicki Laskier: FIECON Ltd
Mark Fisher: FIECON Ltd
W. Richey Neuman: Portola Pharmaceuticals, Inc
Iwona Bucior: Portola Pharmaceuticals, Inc
Steven Deitelzweig: Ochsner Clinic Foundation and The University of Queensland School of Medicine, Ochsner Clinical School
Alexander T. Cohen: Guy’s and St, Thomas’ Hospitals

PharmacoEconomics, 2019, vol. 37, issue 5, No 7, 714 pages

Abstract: Abstract 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.

Date: 2019
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DOI: 10.1007/s40273-018-0757-8

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