{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T04:20:27Z","timestamp":1775103627767,"version":"3.50.1"},"reference-count":51,"publisher":"American Society of Clinical Oncology (ASCO)","issue":"8","content-domain":{"domain":["ascopubs.org"],"crossmark-restriction":true},"short-container-title":["JCO Oncology Practice"],"published-print":{"date-parts":[[2021,8]]},"abstract":"<jats:sec><jats:title>PURPOSE:<\/jats:title><jats:p> Two recent clinical trials have demonstrated that direct oral anticoagulants (DOACs) are effective as venous thromboembolism (VTE) prophylaxis in patients with moderate-to-high risk ambulatory cancer initiating chemotherapy. Patients with advanced ovarian cancer receiving neoadjuvant chemotherapy are at particularly increased risk of VTE. We performed a cost-effectiveness analysis from a health system perspective to determine if DOACs are a feasible prophylactic strategy in this population. <\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS:<\/jats:title><jats:p> A simple decision tree was created from a health system perspective, comparing two strategies: prophylactic DOAC taken for 18 weeks during chemotherapy versus no VTE prophylaxis. Rates of VTE (7.3% DOAC v 13.6% no treatment), major bleeding (2.6% v 1.3%), and clinically relevant nonmajor bleeding (4.6% v 3.3%) were modeled. Cost estimates were obtained from wholesale drug costs, published studies, and Medicare reimbursement data. Probabilistic, one-way, and two-way sensitivity analyses were performed. <\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS:<\/jats:title><jats:p> In the base case model, DOAC prophylaxis is more costly and more effective than no therapy (incremental cost-effectiveness ratio = $256,218 in US dollars\/quality-adjusted life year). In one-way sensitivity analyses, reducing the DOAC cost by 32% or raising the baseline VTE rate above 18% renders this strategy potentially cost-effective with an incremental cost-effectiveness ratio below $150,000 in US dollars\/quality-adjusted life year. <\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSION:<\/jats:title><jats:p> Further confirmation of the true baseline VTE rate among women initiating neoadjuvant chemotherapy for ovarian cancer will determine whether prophylactic dose DOAC is a value-based strategy. Less costly VTE prophylaxis options such as generic DOACs (once available) and aspirin also warrant investigation. <\/jats:p><\/jats:sec>","DOI":"10.1200\/op.20.00783","type":"journal-article","created":{"date-parts":[[2021,4,29]],"date-time":"2021-04-29T19:59:35Z","timestamp":1619726375000},"page":"e1075-e1084","update-policy":"https:\/\/doi.org\/10.1200\/crossmark","source":"Crossref","is-referenced-by-count":14,"title":["Cost-Effectiveness of Venous Thromboembolism Prophylaxis During Neoadjuvant Chemotherapy for Ovarian Cancer"],"prefix":"10.1200","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5909-9178","authenticated-orcid":false,"given":"Emma S.","family":"Ryan","sequence":"first","affiliation":[{"name":"Duke University School of Medicine, Durham, NC"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4259-5992","authenticated-orcid":false,"given":"Laura 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