Apixaban for the prevention of venous thromboembolism in people ...

The NICE clinical guideline on reducing the risk of VTE in patients admitted to hospital (CG92)
recommends that dabigatran etexilate (starting 1 to 4 hours after surgery), fondaparinux sodium
(starting 6 hours after surgical closure provided haemostasis has been established), low molecular
weight heparin (LMWH) (starting 6–12 hours after surgery), rivaroxaban (starting 6–10 hours after
surgery), or unfractionated heparin for patients with renal failure (starting 6–12 hours after surgery)
should be offered in combination with mechanical and pharmacological methods for patients
undergoing elective knee and hip replacement surgery.
The ERG has no concerns with these choices of comparators.
3.4 Outcomes
Do the outcomes in the MS match the outcomes described in the final scope? If not, provide further
details. Consider clinical effectiveness, adverse events, quality of life and health economic outcomes
and a discussion of appropriate mechanisms for measuring these outcomes. Is the focus of the
submission on appropriate outcomes or has it been limited to non-ideal outcomes?
The majority of the key clinical outcomes are considered within the model both in the short term and
in the long term. These are VTEs, PTS, mortality and bleeds.
3.5 Other relevant factors
For example: Does the MS include a section on equity considerations? Is there an ongoing Patient
Access Scheme application?
The ERG considers that the time horizon of the model of 35 years is appropriate for this decision
problem given the mean age of the population of 65 or 68 (depending on sex and whether THR or
TKR); this makes the final age at least 100 years, which approximates a lifetime.
The ERG has listed all concerns in the previous and in the following sections.
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