Total costs of treating venous thromboembolism: implication of different cost perspectives in a Danish setting

Abstract

Aim: Optimal use of scarce resources is a focus in the healthcare sector, as resources devoted to health care are limited. Costs and health economic analyses can help guide decision-making concerning treatments. One important factor is the choice of cost perspective that can range from a focus on narrow drug budget costs to broader economic perspectives. In the case of treatment with oral anticoagulants in patients with venous thromboembolism (VTE), encompassing deep vein thrombosis and pulmonary embolism, the aim of this cost analysis was to illustrate the differences in costs when applying different cost perspectives.

Methods: In a cost analysis, pairwise comparisons of average costs of 6 months standard treatment with either a low molecular weight heparin parenteral anticoagulant (LMWH) and a Vitamin K Antagonist (VKA) versus one of the non-vitamin K oral anticoagulants [NOACs; dabigatran etexilate, rivaroxaban, apixaban, and edoxaban) used in daily clinical practice in Denmark for VTE patients were carried out. Each analysis included the results from five different cost analyses with increasingly broader cost perspectives going from the narrowest “drug cost only” perspective to the broadest “societal” perspective.

Results: Focusing on “drug costs only”, LMWH/VKA was associated with the lowest costs compared to all NOACs. However, including the economic impact of preventing recurrent VTE and limit bleedings, apixaban and rivaroxaban resulted in slightly lower health care costs than LMWH/VKA. When applying the “societal perspective”, the total costs saved with apixaban and rivaroxaban compared to LMWH/VKA further increased, with apixaban having the lowest total costs.

Conclusions: The present study’s case of oral anticoagulants in VTE treatment illustrated the importance of the cost perspective in the choice of therapy. If decision-making were based on drug costs only, instead of applying a health care sector or societal cost perspective, suboptimal decisions may be likely.

Keywords:

• Venous thromboembolism
• societal costs
• total costs
• cost perspectives
• recurrent VTE
• bleedings

Transparency

Declaration of funding

This study was financed by Pfizer, Denmark and Bristol-Myers Squibb, Denmark.

Declaration of financial/other relationships

Agnete Nielsen and Jens Olsen are employees of Incentive. The Incentive was a paid vendor to Pfizer Denmark and Bristol-Myers Squibb Denmark. Thomas Kümler was a paid clinical consultant of Pfizer Denmark and Bristol-Myers Squibb Denmark in the present study. Peter Bo Poulsen and Lars Dybro are employees of Pfizer Denmark and both own shares in Pfizer Inc. Bitten Kloster and Anette Lorentzen are employees of Bristol-Myers Squibb Denmark. JME peer reviewers on this manuscript have received an honorarium from JME for their review work, but have no other relevant financial relationships to disclose.

Author contributions

All authors were involved in the conception and design of the analysis. Agnete Nielsen and Jens Olsen performed the analyses and drafted the manuscript. All authors revised and commented the manuscript critically and approved the final version. All authors agree to be accountable for all aspects of the work.

Acknowledgements

No assistance in the preparation of this article is to be declared.