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.
Keywords
cost-effectiveness - venous thrombosis - apixaban - lifelong treatment - non–vitamin
K oral anticoagulants
