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

机译：荷兰静脉血栓栓塞预防延长治疗：临床和经济效益

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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.
机译：摘要背景荷兰指南建议延长抗凝血治疗与直接口服抗凝血剂或维生素K拮抗剂，用于特发性静脉血栓栓塞（VTE）没有出血风险的患者。目的这项研究的目的是分析荷兰Apixaban扩展治疗的经济影响，基于更新和适应的先前发表的模型。方法我们进行了成本效益分析，模拟了1,000名VTE患者的群体。基本情况分析与前6个月后的延长性Apixaban治疗与未治疗相比。进行了五种额外的情景，以评估不同出血风险和医疗支付者的观点的效果。该模型的主要结果是每个质量调整的寿命（QALY）成本（€）的增量成本效益比（QALY），其中一个QALY定义为完美健康的1年。为了考虑模型中的不确定性的任何影响，进行了概率和单变量敏感性分析。治疗被认为是成本效益的，少于20,000欧元/ QALY，这是荷兰预防毒品的最常用意愿（WTP）阈值。结果该模型显示复发VTE的减少，在所有情况下，延长治疗的主要出血事件没有增加。基本案例分析显示了€9,653 / QALY的标语。基本案例中Apixaban成本效益的可能性分别为20,000欧元/ QALY和50,000欧元/ QALY的WTP阈值为70.0％和91.4％。结论延长治疗Apixaban对于预防荷兰患者的复发性VTE具有成本效益。

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