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

5.4 Conclusions
Describe the completeness of the MS with regard to relevant cost effectiveness studies and data
described in any de novo economic evaluations. Does the submission contain an unbiased estimate of
the technology’s ICERs in relation to relevant populations, interventions comparators and outcomes?
Are there any remaining uncertainties about the reliability of the cost effectiveness evidence?
Reference should also be made concerning the extent to which the submitted evidence reflects the
decision problem defined in the final scope.
The ERG believes that the MS represents an unbiased attempt to assess the cost-effectiveness of
apixaban for the prevention of VTE in people undergoing THR or TKR.
The ERG comment that the absolute incremental differences between apixaban and the comparators
are small, and based on only one or two trials per comparator. New evidence from future trials may
therefore impact the current cost-effectiveness results. Also, were health providers to negotiate prices
for interventions that were markedly different to those assumed within the analyses, then conclusions
on the intervention that is most likely to be cost-effective may change.
6 Impact on the ICER of additional clinical and economic analyses undertaken by the
ERG
Where appropriate, this section should include a table which shows (i) the effect of any major clinical
or cost parameter change or structural change on the size of the base-case ICER and (ii) the effect of
making all changes simultaneously on the size of the base-case ICER.
The additional analysis undertaken by the ERG resulted in a lower ICER for apixaban as opposed to
fondaparinux. This however does not change the conclusion that, based on the deterministic results,
apixaban is deemed cost-effective as opposed to fondaparinux.
7 End of life
Where appropriate, this section should summarise the manufacturer’s case for using the NICE end of
life treatment criteria and discuss to what extent the manufacturer’s argument is valid.
Not applicable.
8 Conclusions
The section should focus on any difference(s) of opinion between the manufacturer and the ERG that
might influence the size of the ICER. Priority should be focussed on discussing information that will
be useful to the Appraisal Committee including strengths, weaknesses and remaining uncertainties.
Further summary of evidence is not required in this section.
The MS appears to contain an unbiased estimate of the treatment effect of apixaban in relation to the
relevant outcomes and the comparator, enoxaparin. Overall the evidence from the three ADVANCE
trials in the MS indicates that apixaban 2.5mg bd is significantly superior to the comparator
enoxaparin (40mg od) in terms of xxxxxxxxxxxx, any DVT, xxxxxxxxx. Xxxxx xxxxxxxx xxxxxx
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