Research conducted by UC Davis Comprehensive Cancer Center and the University of Cincinnati shows that direct oral anti-coagulant (DOAC) drugs are more effective and are more cost-effective than low molecular weight heparin (LMWH) for treating cancer-associated thrombosis (CAT).
A new study to be published in the Annals of Internal Medicine on December 27, 2022, examines the cost-effectiveness of the four most utilized anticoagulation strategies for blood clots, which include LMWH, apixaban, edoxaban and rivaroxaban. Authors of the study include oncologist and Assistant Professor of Medicine Shuchi Gulati, a clinician scientist with UC Davis, and Professor Emeritus of Clinical Medicine Mark H. Eckman with the University of Cincinnati.
These drugs were compared head-to-head using a computer model Eckman and Gulati constructed that simulates major health events that happen to a cohort of patients with cancer over time who have experienced a blood clot. The model simulates events including recurrent pulmonary emboli, recurring DVT without pulmonary emboli, major bleeds and clinically relevant non-major bleeds as well as mortality. Then, over the course of the lifetime of the patient cohort, the study examined the accumulating lifetime costs and lifetime effectiveness measured in a metric called quality-adjusted life years (QALYs).
In the base-case analysis, using the cost of drugs purchased at a federal facility such as the Veteran’s Administration, apixaban was favored as being more effective and less costly than either LMWH or edoxaban while indicating rivaroxaban was not cost-effective. However, the study results were vastly different when analyzing average prices from GoodRx, a free online service that provides drug coupons for discounts on medications. In this scenario, if decision makers were unwilling to spend more than $50,000 per QALY, edoxaban was favored, and using the contemporary threshold for societal willingness to pay, rivaroxaban was cost-effective, with an incremental cost-effectiveness ratio of just more than $50,000 per QALY.
