Oralanticoagulants found to be more effective and cost-effective than heparin for cancer-associated thrombosis acpinternists AnnalsofIM
A cost-effectiveness analysis comparing direct oral anticoagulants to low-molecular-weight heparin found that DOACs are both more medically effective and cost-effective than LMWH when treating cancer-associated thrombosis . These findings may inform decisions on the clinical level as well as policy decisions. The analysis is published inCAT is associated with an almost two-fold increase in mortality compared with patients with cancer but without thrombosis.
In their analysis, the authors found that apixaban was the least costly anticoagulant and was more effective than either LMWH or edoxaban. However, rivaroxaban was slightly more effective than apixaban, with an ICER of $493,246 per quality-adjusted life-year . However, when the prices of drugs from GoodRx were modeled, rivoroxaban became most cost effective using contemporary threshold for societal willingness to pay.
The authors note their findings demonstrated a stark difference between the real-world cost of DOACs and thefrom U.S. Department of Veterans Affairs Federal Supply Schedule, have implications for value-based price benchmarks in the United States. The authors also add that the most clinically effective and cost effective DOAC depend on a patient's clinical characteristics, location of cancer, and side effects, as well as the relative cost of each DOAC.
An accompanying editorial from authors at the Yale School of Medicine notes that while this analysis may underestimate the cost-effectiveness of apixaban in the real world, it shines by showing the benefit of aligning drug cost with effectiveness.
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