Budget impact analysis of betrixaban for venous thromboembolism prophylaxis in nonsurgical patients with acute medical illness in the United Kingdom

ABSTRACT

Objectives

Venous thromboembolism (VTE) incurs substantial costs to the UK National Health Service (NHS). Betrixaban is approved in the US for VTE prophylaxis with a recommended 35–42 days of treatment. This analysis modeled the budget impact of introducing betrixaban for extended-duration VTE prophylaxis in nonsurgical patients with acute medical illness at risk of VTE in the UK, where it is not yet licensed.

Methods

The 5-year budget impact of introducing betrixaban into current prophylaxis (low molecular weight heparin and fondaparinux) was estimated for the UK NHS. The Phase 3 APEX study provided primary event (VTE, myocardial infarction, ischemic stroke, and death; all-cause or VTE-related) and treatment complications data. Literature informed risk of recurrent events and long-term complications, population, market share, and costs for treatment and management of events. Network meta-analyses informed symptomatic DVT, pulmonary embolism and VTE-related death rates in fondaparinux patients. Deterministic sensitivity analyses explored uncertainty.

Results

Introducing betrixaban accrued savings of £1,290,000-£23,000,000 in years 1–5. Savings were from reduced primary VTE events, which reduced recurrent events and future complications. All sensitivity analyses showed savings.

Conclusion

Introducing extended-duration VTE prophylaxis with betrixaban in the UK would accrue substantial savings annually over the next 5 years compared to current prophylaxis.

Clinical trial registration: www.clinicaltrials.gov identifier is NCT01583218.

KEYWORDS:

• Betrixaban
• budget impact
• prophylaxis
• venous thromboembolism
• UK

Article Highlights

• In this analysis, the introduction of extended-duration VTE prophylaxis with betrixaban accrued cost savings compared to short-term prophylaxis with low molecular weight heparin (LMWH) and fondaparinux.

• Use of betrixaban-reduced costs associated with primary and recurrent event treatment, driving a reduced budget impact relative to the prophylaxis regimens included in this analysis.

• Introduction of betrixaban was cost saving for all years, with savings of £1,291,365 in Year 1, which increased to savings of £23,000,783 in Year 5.

• Sensitivity analyses showed the robustness of results since overall savings were still observed over 5 years under the variation of each parameter.

• Using betrixaban extended-duration VTE prophylaxis rather than LMWH or fondaparinux prophylaxis should reduce the economic burden of care for nonsurgical patients with acute medical illness at risk of VTE in the UK NHS.

Declaration of interest

H Guy, V Laskier, and M Fisher are employees of FIECON Ltd, a health-economics outcomes research agency, which performed the analyses presented in the manuscript. I Bucior is a former employee of Portola Pharmaceuticals, Inc. S Deitelzweig has received consulting fees or honoraria, fees for the provision of medicines, equipment, or administrative support, and payment for lectures from Portola Pharmaceuticals, Inc., Pfizer, Jannsen and BMS. He has received support for travel to meetings from Portola Pharmaceuticals, Inc., and fees for expert testimony from Jannsen. AT Cohen has received consulting fees, research support, and honoraria from AbbVie, ACI Clinical, Aspen, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Boston Scientific, CSL Behring, Daiichi-Sankyo, GlaxoSmithKline, GLG, Guidepoint Global, Johnson and Johnson, Leo Pharma, Medscape, McKinsey, Navigant, ONO, Pfizer, Portola, Sanofi, Takeda, Temasek Capital, and TRN. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer Disclosures

A reviewer on this manuscript has disclosed that they participated as a consultant for Portola Pharmaceuticals March 2019 (related to andexanet not betrixaban). Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.

Author Contribution Statement

HG, VL, MF, and ATC were involved in the design and execution of the analysis. All authors were involved in the interpretation of the results, drafting and revising this manuscript, and provided final approval of the version to be published. All authors vouch for the accuracy of the content included in the full manuscript and agree to be accountable for all aspects of the work. The authors thank Aimee North and Augusta Connor for their writing and editing assistance (FIECON Ltd).

Data availability statement

The authors confirm that the data supporting the findings of this study are available within the article and/or its supplementary materials.

Supplementary material

Supplemental data for this article can be accessed here.

Additional information

Funding

This analysis was supported by Portola Pharmaceuticals, Inc.