Cost-effectiveness of Apixaban versus Dalteparin for prevention of recurrent thrombosis in cancer patients

Introducción: La tasa de incidencia del tromboembolismo venoso (TEV) en pacientes con cáncer es de 5.8 por 100 años/persona. El pilar del tratamiento son las HBPM las cuales están asociadas a mala adherencia por el tipo de administración. Apixaban es un nuevo anticoagulante oral que ha demostrado no ser inferior en el tratamiento de TEV con respecto a otros anticoagulantes, sin mayor impacto en el sangrado mayor y supervivencia del paciente. Objetivo: Analizar la Costo-efectividad de apixaban frente a dalteparina para la prevención de trombosis venosa en pacientes con cáncer en Colombia. Materiales y métodos: Se determinaron desenlaces de eficacia mediante revisión de literatura. La perspectiva del estudio es la del Sistema General de Seguridad Social Integral Colombiano en una cohorte hipotética de 20.000 pacientes con un horizonte temporal a 6 meses. Los costos se recuperaron del manual tarifario SOAT vigente. Resultados: la cohorte de pacientes con apixaban presentó menos eventos trombóticos (5,6% vs 7,9%), menos sangrado mayor (3,8% vs 4,0%) y más episodios de sangrado menor (9% vs 6%). La diferencia de costos de 6 meses de tratamiento fue de COP 19.184.797.395 a favor de Apixaban. Conclusiones: El uso de apixaban en pacientes con cáncer para la profilaxis de eventos tromboembolicos demuestra ser costo efectivo comparado con dalteparina; aumentando su seguridad cuando se reservó la dalteparina para los pacientes con cáncer esofágico y gastroesofágico por su mejor perfil de seguridad en esta población.Introduction: The incidence rate of venous thromboembolism in cancer patients is 5.8 per 100 years / person. The mainstay of treatment is LMWH, which is associated with poor adherence due to the type of administration. Apixaban is a new oral anticoagulant which has been shown not to be inferior in the treatment of VTE with respect to other anticoagulants in terms of its effectiveness, with no major impact on major bleeding and patient survival. Objective: To analyze the cost-effectiveness of apixaban versus dalteparin for the prevention of venous thrombosis in cancer patients in Colombia. Materials and methods: In this study, efficacy outcomes were determined by literature review and costs were assigned in terms of diagnosis and treatment of efficacy and safety events; the perspective of the study is that of the Colombian General Comprehensive Social Security System in a hypothetical cohort of 20,000 patients with a time horizon of 6 months. Results: the cohort of patients with apixaban presented fewer thrombotic events (5.6% vs 7.9%), less major bleeding (3.8% vs 4.0%) and more episodes of minor bleeding (9% vs 6%). On the other hand, considering the cost of intervention in a 6-month treatment, it was shown that the use of apixaban was cheaper than that of dalteparin; with a difference of COP 19,184,797,395 between cohorts according to the Colombian tariff manual. Conclusions: The use of apixaban in cancer patients for the prophylaxis of thromboembolic events proves to be cost effective compared to dalteparin; increasing its safety when dalteparin was reserved for patients with esophageal and gastroesophageal cancer due to its better safety profile in this population