{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,20]],"date-time":"2025-08-20T13:15:39Z","timestamp":1755695739313,"version":"3.33.0"},"reference-count":0,"publisher":"Canadian Society of Healthcare-Systems Pharmacy","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["CJHP"],"abstract":"<p><strong>ABSTRACT<\/strong><\/p><p><strong>Background:<\/strong> To date, there have been few economic evaluations, from a Canadian perspective, of direct oral anticoagulants (DOACs) for the prevention of recurrent venous thromboembolism (VTE) in patients with acute unprovoked VTE. As a result, there is a lack of consensus about which treatment strategy should be adopted in the clinical setting.<\/p><p><strong>Objectives:<\/strong> To assess the cost-effectiveness of currently approved anti - coagulant options, in terms of cost per quality-adjusted life-year (QALY) gained, for the prevention of recurrent VTE in patients with unprovoked events managed on an outpatient basis.<\/p><p><strong>Methods:<\/strong> Microsoft Excel was used to develop a Markov model. Model parameters were determined using published literature, local hospital data, expert opinion, and chart review. The analysis considered the costs associated with pharmaceuticals, laboratory testing, hematologist fees, and treatment of recurrent VTE and major bleeding events. Effectiveness was measured in terms of QALYs, and incremental cost-effectiveness ratios (ICERs) were calculated.<\/p><p><strong>Results:<\/strong> For treatment lasting 3 months, apixaban represented the most cost-effective DOAC relative to low-molecular-weight heparin (LMWH) + vitamin K antagonist, with an ICER of $7379.66. For 6 months of treatment, apixaban again represented the most cost-effective treatment, with an ICER of $84.08 per QALY gained, and this drug dominated all the other strategies at 12 months. For lifetime treatment, DOACs were unlikely to be cost-effective, given a maximum willingness to pay of $50 000 to $100 000 per QALY. In a probabilistic sensitivity analysis at 6 months, 46.4% of iterations resulted in apixaban having lower costs and better outcomes than LMWH + vitamin K antagonist, and 78.6% of iterations resulted in an ICER below $100 000<\/p><p><strong>Conclusions:<\/strong> The findings of this study suggest that apixaban is likely cost-effective for treatment durations of 3, 6, and 12 months. However, for indefinite treatment, DOACs were unlikely to be cost-effective.<\/p><p><strong>R\u00c9SUM\u00c9<\/strong><\/p><p><strong>Contexte :<\/strong> \u00c0 ce jour, on a r\u00e9alis\u00e9 peu d\u2019\u00e9valuations \u00e9conomiques, d\u2019un point de vue canadien, sur les anticoagulants oraux directs (AOD) utilis\u00e9s dans la pr\u00e9vention de la thromboembolie veineuse (TEV) r\u00e9currente chez les patients atteints de TEV idiopathique aigu\u00eb. Pour cette raison, aucun consensus n\u2019a \u00e9t\u00e9 \u00e9tabli quant \u00e0 la strat\u00e9gie th\u00e9rapeutique \u00e0 adopter en milieu clinique.<\/p><p><strong>Objectif :<\/strong> \u00c9valuer le rapport co\u00fbt-efficacit\u00e9 des anticoaguloth\u00e9rapies actuellement approuv\u00e9es, en ce qui a trait au co\u00fbt par ann\u00e9e de vie pond\u00e9r\u00e9e par la qualit\u00e9 (QALY) gagn\u00e9e, pour la pr\u00e9vention de la TEV r\u00e9currente chez les patients ayant subi des \u00e9v\u00e9nements idiopathiques qui ont \u00e9t\u00e9 trait\u00e9s en consultation externe.<\/p><p><strong>M\u00e9thodes :<\/strong> Le logiciel Excel de Microsoft a servi \u00e0 cr\u00e9er un mod\u00e8le de Markov. Les param\u00e8tres du mod\u00e8le ont \u00e9t\u00e9 \u00e9tablis \u00e0 l\u2019aide de la litt\u00e9rature, de donn\u00e9es de l\u2019h\u00f4pital local, d\u2019opinions d\u2019experts et d\u2019une analyse de dossiers m\u00e9dicaux. L\u2019analyse prenait en compte les co\u00fbts associ\u00e9s aux m\u00e9dicaments, aux examens de laboratoire, aux honoraires d\u2019h\u00e9matologues et au traitement de la TEV r\u00e9currente et d\u2019h\u00e9morragies importantes. L\u2019efficacit\u00e9 \u00e9tait mesur\u00e9e en nombre de QALY et les rapports co\u00fbtefficacit\u00e9 diff\u00e9rentiels ont \u00e9t\u00e9 calcul\u00e9s.<\/p><p><strong>R\u00e9sultats :<\/strong> Pour un traitement de trois mois, l\u2019apixaban repr\u00e9sentait l\u2019AOD offrant le meilleur rapport co\u00fbt-efficacit\u00e9 comparativement \u00e0 l\u2019h\u00e9parine de bas poids mol\u00e9culaire (HBPM) + un antagoniste de la vitamine K; il pr\u00e9sentait un rapport co\u00fbt-efficacit\u00e9 diff\u00e9rentiel de 7379,66 $. Pour un traitement de six mois, l\u2019apixaban repr\u00e9sentait \u00e0 nouveau le traitement le plus efficace par rapport au co\u00fbt; il pr\u00e9sentait un rapport co\u00fbt-efficacit\u00e9 diff\u00e9rentiel de 84,08 $ par QALY gagn\u00e9e. Ce m\u00e9dicament surclassait toutes les autres strat\u00e9gies apr\u00e8s douze mois de traitement. En ce qui concerne un traitement \u00e0 vie, les AOD offraient probablement un moins bon rapport co\u00fbt-efficacit\u00e9, compte tenu d\u2019une propension \u00e0 payer maximale se situant entre 50 000 $ et 100 000 $ par QALY. Dans une analyse de sensibilit\u00e9 probabiliste au sixi\u00e8me mois de traitement, 46,4 % des it\u00e9rations se traduisaient par des co\u00fbts moins \u00e9lev\u00e9s et de meilleurs r\u00e9sultats pour l\u2019apixaban relativement \u00e0 l\u2019HBPM + un antagoniste de la vitamine K. De plus, 78,6 % des it\u00e9rations se traduisaient par un rapport co\u00fbt-efficacit\u00e9 diff\u00e9rentiel de moins de 100 000 $.<\/p><p><strong>Conclusions :<\/strong> Ces r\u00e9sultats laissent croire que l\u2019apixaban pr\u00e9sente probablement un rapport co\u00fbt-efficacit\u00e9 int\u00e9ressant pour les traitements d\u2019une dur\u00e9e de 3, 6 et 12 mois. Cependant, en ce qui concerne un traitement d\u2019une dur\u00e9e ind\u00e9termin\u00e9e, les AOD ne sont sans doute pas avantageux.<\/p><\/jats:p>","DOI":"10.4212\/cjhp.v70i3.1658","type":"journal-article","created":{"date-parts":[[2017,7,11]],"date-time":"2017-07-11T16:20:40Z","timestamp":1499790040000},"source":"Crossref","is-referenced-by-count":5,"title":["Direct Oral Anticoagulants and Vitamin K Antagonists for Treatment of Deep Venous Thrombosis and Pulmonary Embolism in the Outpatient Setting: Comparative Economic Evaluation"],"prefix":"10.4212","volume":"70","author":[{"given":"Abdullah S","family":"Al Saleh","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patrick","family":"Berrigan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Anderson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sudeep","family":"Shivakumar","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2732","published-online":{"date-parts":[[2017,6,30]]},"container-title":["The Canadian Journal of Hospital Pharmacy"],"original-title":[],"link":[{"URL":"http:\/\/www.cjhp-online.ca\/index.php\/cjhp\/article\/viewFile\/1658\/2552","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/www.cjhp-online.ca\/index.php\/cjhp\/article\/viewFile\/1658\/2571","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/www.cjhp-online.ca\/index.php\/cjhp\/article\/viewFile\/1658\/2571","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2017,7,11]],"date-time":"2017-07-11T16:20:43Z","timestamp":1499790043000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.cjhp-online.ca\/index.php\/cjhp\/article\/view\/1658"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,6,30]]},"references-count":0,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2017,6,30]]}},"URL":"https:\/\/doi.org\/10.4212\/cjhp.v70i3.1658","relation":{},"ISSN":["1920-2903","0008-4123"],"issn-type":[{"type":"electronic","value":"1920-2903"},{"type":"print","value":"0008-4123"}],"subject":[],"published":{"date-parts":[[2017,6,30]]}}}