Brockbank J, Wolowacz S. Economic evaluations of new oral anticoagulants for the prevention of venous thromboembolism after total hip or total knee replacement. Poster presented at the ISPOR 18th Annual European Congress; November 2015. Milan, Italy.


OBJECTIVES: The objectives of this systematic review were to identify published economic analyses of new oral anticoagulants (NOACs) for primary venous thromboembolism (VTE) prophylaxis following total hip replacement (THR) and total knee replacement (TKR) surgeries and to summarise the modelling techniques used and cost-effectiveness results.

METHODS: Electronic searches of MEDLINE, EconLit, and the Cochrane Library were performed from January 2008 to February 2015 using a combination of Medical Subject Headings and free-text terms that were grouped into the following categories: population (including terms for thromboembolism and orthopaedic surgery), intervention (including terms for apixaban, dabigatran, edoxaban, and rivaroxaban), and study design (including terms for economic analyses).

RESULTS: Sixteen economic analyses were included; all studies used decision-tree structures to model acute prophylaxis, and 13 included a chronic-phase Markov module to capture long-term complications and recurrent VTE events. The model structures generally captured the important events needed to accurately estimate differences in costs and outcomes between different treatment strategies. Eleven studies included rivaroxaban, 9 studies included dabigatran, 3 studies included apixaban, and no studies included edoxaban. The analyses that compared a NOAC with low molecular-weight heparin (LMWH) predominantly resulted in the NOAC dominating LMWH for patients with both THR and TKR. The results of analyses that compared NOACs with each other suggested that dabigatran is the least cost-effective option. There is limited evidence directly comparing rivaroxaban with apixaban, but our results suggested that rivaroxaban dominates apixaban for patients with TKR in the United Kingdom.

CONCLUSIONS: Economic analyses of NOACs for primary VTE prophylaxis following THR and TKR surgeries show reasonable consistency in the model structures used and events captured. The results strongly suggest that NOACs are cost-effective alternatives to LMWH. Dabigatran appears to be the least cost-effective NOAC. However, more research is needed to assess the cost-effectiveness of apixaban and edoxaban.

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