Economic Analysis Comparing Dalteparin to Vitamin K Antagonists to Prevent Recurrent Venous Thromboembolism in Patients With Cancer Having Renal Impairment
| Autor: | George Dranitsaris, Laura Burgers, Lesley G Shane, Seth Woodruff |
|---|---|
| Rok vydání: | 2016 |
| Předmět: |
Adult
Dalteparin Male medicine.medical_specialty Vitamin K Cost effectiveness medicine.drug_class Cost-Benefit Analysis Low molecular weight heparin Subgroup analysis 030204 cardiovascular system & hematology law.invention 03 medical and health sciences Young Adult 0302 clinical medicine Randomized controlled trial law Recurrence Internal medicine medicine Humans Renal Insufficiency Aged Aged 80 and over Univariate analysis business.industry Hazard ratio Cancer Anticoagulants Hematology General Medicine Venous Thromboembolism Heparin Low-Molecular-Weight Middle Aged medicine.disease Surgery 030220 oncology & carcinogenesis Relative risk Female business |
| Zdroj: | Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis. 22(7) |
| ISSN: | 1938-2723 |
| Popis: | Background: In a randomized trial (ie, Comparison of Low-Molecular-Weight Heparin versus Oral Anticoagulant Therapy for the Prevention of Recurrent Venous Thromboembolism in Patients with Cancer [CLOT]) that evaluated secondary prophylaxis of recurrent venous thromboembolism (VTE) in patients with cancer, dalteparin reduced the relative risk by 52% compared to oral vitamin K antagonists (VKAs; hazard ratio = 0.48, P = .002). A recent subgroup analysis in patients with moderate to severe renal impairment also revealed lower absolute VTE rates with dalteparin (3% vs 17%; P = .011). To measure the economic value of dalteparin in these populations, a pharmacoeconomic analysis was conducted from the Dutch health-care system perspective. Methods: Resource utilization data contained within the CLOT trial database were extracted and converted into direct cost estimates. Univariate analysis was then conducted to compare the total cost of therapy between patients randomized to dalteparin or VKA therapy. Health state utilities were then measured in 24 members of the general public using the time trade-off technique. Results: When all of the cost components were combined for the entire population (n = 676), the dalteparin group had significantly higher overall costs than the VKA control group (dalteparin = €2375 vs VKA = €1724; P < .001). However, dalteparin was associated with a gain of 0.14 (95% confidence interval [CI]: 0.10-0.18) quality-adjusted life years (QALYs) over VKA. When the incremental cost was combined with the utility gain, dalteparin had a cost of €4,697 (95% CI: €3824-€4951) per QALY gained. Conclusion: Secondary prophylaxis with dalteparin is a cost-effective alternative to VKA for the prevention of recurrent VTE in patients with cancer. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|