BACKGROUND: Venous thromboembolism (VTE) is the third most common acute cardiovascular disease. VTE includes both pulmonary embolism (PE) and deep vein thrombosis (DVT) and represents an important clinical burden for patients and significant expenses for payers. Currently, the most prescribed treatment in the UK is the combination of warfarin with a parenteral anticoagulant during the first few days. The aim of this analysis was to develop a health-economic evaluation in order to estimate the cost-effectiveness of edoxaban, a non-VKA oral anticoagulant, in the treatment and secondary prevention of VTE compared to warfarin.
METHODS: A Markov model was built using data from the Hokusai-VTE randomized controlled trial to estimate the lifetime costs and quality-adjusted life years (QALYs) in patients with VTE treated with either edoxaban or warfarin in the UK over a lifetime horizon. The model included VTE events, the occurrence of VTE-related complications and adverse events associated with anticoagulation treatment, i.e. bleeds. The VTE related complications included in the model are post-thrombotic syndrome and chronic thromboembolic pulmonary hypertension. The base case assumed initial treatment duration of 6 months after a first VTE event, followed by flexible treatment duration after recurrence, i.e. tertiary prevention.
RESULTS: From an NHS perspective Edoxaban was estimated to be cost-effective vs. warfarin with an incremental cost-effectiveness ratio (ICER) of £927 per QALY. The reduction of patient management costs, specifically monitoring costs, outweighed the higher drug costs of edoxaban vs warfarin. The results were similar in all subgroups (split by index VTE type) with a maximum ICER of £1,096 per QALY. Edoxaban was cost-effective versus warfarin in 99.8% of cases in the probabilistic sensitivity analysis when considering a threshold of £20,000 per QALY gained.
CONCLUSION: Edoxaban represents a cost-effective alternative compared to warfarin in the treatment of patients with VTE in the UK.