Cost-effectiveness of low-molecular-weight heparin for secondary prophylaxis of cancer-related venous thromboembolism

Drahomir Aujesky; Kenneth J. Smith; Jacques Cornuz; Mark S. Roberts

doi:10.1160/TH04-11-0767

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2005; 93(03): 592-599
DOI: 10.1160/TH04-11-0767

Cellular Proteolysis and Oncology

Schattauer GmbH

Cost-effectiveness of low-molecular-weight heparin for secondary prophylaxis of cancer-related venous thromboembolism

Authors

Drahomir Aujesky

¹Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pennsylvania, USA

³Department of Internal Medicine, University of Lausanne, Lausanne, Switzerland

⁵Clinical Epidemiology Center, Institute of Social and Preventive Medicine, University of Lausanne, Lausanne, Switzerland
Kenneth J. Smith

¹Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pennsylvania, USA

²Section of Decision Sciences and Clinical Systems Modeling, Department of Medicine, University of Pittsburgh, Pennsylvania, USA
Jacques Cornuz

³Department of Internal Medicine, University of Lausanne, Lausanne, Switzerland

⁴University Outpatient Clinic, University of Lausanne, Lausanne, Switzerland

⁵Clinical Epidemiology Center, Institute of Social and Preventive Medicine, University of Lausanne, Lausanne, Switzerland
Mark S. Roberts

¹Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pennsylvania, USA

²Section of Decision Sciences and Clinical Systems Modeling, Department of Medicine, University of Pittsburgh, Pennsylvania, USA

Abstract

Summary

Although extended secondary prophylaxis with low-molecular-weight heparin was recently shown to be more effective than warfarin for cancer-related venous thromboembolism, its cost-effectiveness compared to traditional prophylaxis with warfarin is uncertain. We built a decision analytic model to evaluate the clinical and economic outcomes of a 6-month course of low-molecular-weight heparin or warfarin therapy in 65-year-old patients with cancer-related venous thromboembolism. We used probability estimates and utilities reported in the literature and published cost data. Using a US societal perspective, we compared strategies based on quality-adjusted life-years (QALYs) and lifetime costs. The incremental cost-effectiveness ratio of low-molecular-weight heparin compared with warfarin was $149, 865/QALY. Low-molecular-weight heparin yielded a quality-adjusted life expectancy of 1.097 QALYs at the cost of $15, 329. Overall, 46% ($7108) of the total costs associated with low-molecular-weight heparin were attributable to pharmacy costs. Although the low-molecular-weigh heparin strategy achieved a higher incremental quality-adjusted life expectancy than the warfarin strategy (difference of 0.051 QALYs), this clinical benefit was offset by a substantial cost increment of $7,609. Cost-effectiveness results were sensitive to variation of the early mortality risks associated with low-molecular-weight heparin and warfarin and the pharmacy costs for low-molecular-weight heparin. Based on the best available evidence, secondary prophylaxis with low-molecular-weight heparin is more effective than warfarin for cancer-related venous thromboembolism. However, because of the substantial pharmacy costs of extended low-molecular-weight heparin prophylaxis in the US, this treatment is relatively expensive compared with warfarin.

Keywords

Cost-effectiveness - treatment - cancer - venous thromboembolism

Full Text

References

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