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

Of the 14 included studies the manufacturer found the two studies by Wolowacs 42, 43 the STA
reports, 34, 47-49 and the NICE guideline 3 to be most relevant. According to the manufacturer the
remaining studies were either not relevant because of publication date (too old), jurisdiction (Ireland),
or not reporting QALYs. The main findings of the relevant studies, excluding the NICE guideline are
listed in Table 5.1.
5.1.4 What does the review conclude from the data available? Does the ERG agree with the
conclusions of the cost effectiveness review? If not, provide details.
Both Davies and Saltzman (TKR only) 37 and the NICE VTE clinical guideline 3 concluded that
prophylaxis was superior to no prophylaxis in TKR and THR. In terms of injectable prophylaxis
Drummond et al. 38 found the LMWH enoxaparin to be cost effective on a per patient cost compared
to unfractionated heparin (THR patients). Davies et al. 36 found that extended enoxaparin (21 days post
discharge) was cost effective compared with enoxaparin for the hospital admission period only, with a
cost per incremental QALY of £5,732 in THR patients. Gordois et al. 39 found fondaparinux to be cost
effective compared to enoxaparin in THR and TKR with less VTE events and a lower per person cost;
this result was sensitive to the difference in the price of the drugs and the rate of late DVT assumed.
Nicolaides and Bosanquet 41 found desirudin to be more cost effective than enoxaparin with a cost per
life year saved of £2,566. The new oral anticoagulant dabigatran was found to dominate enoxaparin in
TKR and THR at a dose of 220mg od. 42, 43, 47, 48 150mg od of dabigatran dominated enoxaparin in
THR and the reverse was found in TKR. 47, 48 Fondaparinux was cost effective compared to dabigatran
220mg od and 150mg od in THR and TKR with ICERs below £12,000 per QALY. 47, 48 Rivaroxaban
40, 44-46, 49
was found to dominate both enoxaparin and dabigatran in TKR and THR.
Comment
The ERG agrees with the conclusions of the cost-effectiveness review.
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