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Evaluation of medical costs avoided when new oral anticoagulants are used for extended treatment of venous thromboembolism based on clinical trial results

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Abstract

This study evaluated avoidances in medical costs associated with clinical endpoints from randomized clinical trials that evaluated the efficacy and safety of the new oral anticoagulants (NOACs), dabigatran, rivaroxaban, and apixaban for extended treatment of patients with venous thromboembolism (VTE). Event rates of efficacy and safety endpoints from the clinical trials (RE-SONATE, EINSTEIN-EXT, and AMPLIFY-EXT) were obtained from published literature. Incremental annual medical costs among patients with clinical events from a US payer perspective were obtained from the literature or healthcare claims databases and inflation adjusted to 2013 costs. Differences in total medical costs associated with clinical endpoints for patients treated with NOACs versus placebo were then estimated. One-way univariate and Monte Carlo sensitivity analyses were additionally carried out. In all three NOAC trials lower rates of recurrent VTE occurred with NOAC use versus placebo. As a result of the reduction in VTE recurrence the overall medical costs avoided were −$2,794, −$2,948, −$4,249, and −$4,244 for VTE patients treated with dabigatran, rivaroxaban, apixaban 2.5 mg, and apixaban 5 mg respectively versus patients treated with placebo. Apixaban was associated with the greatest avoidance in medical costs, which was driven mainly by a greater reduced rate in recurrent VTE than other NOACs versus placebo and also a reduction in major bleeding rate. Further evaluation is needed to validate these results in the real-world setting.

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Conflict of interest

This research was supported by Bristol-Myers Squibb and Pfizer. Alpesh Amin is a consultant for Novosys Health in connection with conducting this study. Yonghua Jing and John Graham are employees of Bristol-Myers Squibb and own stock in the company. Jeffrey Trocio is an employee of Pfizer and owns stock in the company. Jay Lin and Melissa Lingohr-Smith are employees of Novosys Health, which has received research funds from Bristol-Myers Squibb and Pfizer in connection with conducting this study and development of this manuscript.

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Authors and Affiliations

  1. Department of Medicine, Hospitalist Program, School of Medicine, University of California, Irvine, UCIMC; 101 The City Drive South, Building 58, Room 110, ZC-4076H, Irvine, CA, 92868, USA

    Alpesh Amin

  2. Bristol-Myers Squibb, Plainsboro, NJ, USA

    Yonghua Jing & John Graham

  3. Pfizer, Inc., New York, NY, USA

    Jeffrey Trocio

  4. Novosys Health, Green Brook, NJ, USA

    Jay Lin & Melissa Lingohr-Smith

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  1. Alpesh Amin
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  2. Yonghua Jing
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  3. Jeffrey Trocio
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  4. Jay Lin
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  5. Melissa Lingohr-Smith
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  6. John Graham
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Correspondence to Alpesh Amin.

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Amin, A., Jing, Y., Trocio, J. et al. Evaluation of medical costs avoided when new oral anticoagulants are used for extended treatment of venous thromboembolism based on clinical trial results. J Thromb Thrombolysis 40, 131–138 (2015). https://doi.org/10.1007/s11239-014-1158-2

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  • DOI: https://doi.org/10.1007/s11239-014-1158-2

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