Análisis coste-efectividad y coste-utilidad de apixaban frente a dabigatrán y rivaroxaban en el tratamiento y prevención secundaria del tromboembolismo venoso

Abstract

Objective: Cost-utility analysis of a 6-month treatment of apixaban (10 mg/12 h, first 7 days; 5 mg/12 h, afterwards) for the treatment of the first event of venous thromboembolism (VTE) and prevention of recurrences, versus dabigatran (150 mg/12 h) after 5 days taking low molecular weight heparins (LMWH/dabigatran) and versus rivaroxaban (15 mg/12 h, the first 21 days; 20 mg/day, afterwards). Material and methods: The course of the disease of a 1,000 adult patients was modeled using a life-long Markov model. Efficacy was obtained from a meta-analysis, calculating life years gained (LYG) and quality adjusted life years (QALYs) obtained from the therapeutic options evaluated. Based on a Spanish National Health System (NHS) perspective, only direct medical costs were included. Unit costs (€, 2014) were obtained from literature review and national databases. A 3[%] discount rate was applied for health outcomes and costs. Several sensibility analyses (SA) were performed. Results: Apixaban resulted the most effective therapy with 7.182 LYG and 5.865 QALYs, versus 7.162 LYG and 5.846 QALYs with LMWH/dabigatran and lower total cost (€13,374.70 vs €13,516.50). LYG and QALYs with rivaroxaban were 7.174 and 5.857 and a total cost of €13,537.80. Probabilistic SA confirmed dominance of apixaban versus LMWH/dabigatran and rivaroxaban. Conclusions: Apixaban versus LMWH/dabigatran and versus rivaroxaban was a dominant treatment for the NHS perspective for VTE treatment and prevention of recurrences.