Direct oral anticoagulants versus low-molecular-weight heparin in patients with cancer-associated venous thrombosis: a cost-effectiveness analysis

Figures & data

Figure 1. Markov transition-state model diagram. This chart displays the various health conditions that a patient can experience within the Markov transition-state model. The arrows indicate the possible changes in the patient's health status. The patients are susceptible to several risks, including recurrent deep vein thrombosis (DVT), recurrent pulmonary embolism (PE), intracranial haemorrhage (ICH), non-ICH major bleeding (MB), clinically relevant non-major bleeding (CRNMB), and death. All death states are self-absorbing.

Table 1. Base-case analysis results for a 5-year time horizon.

Time horizon	5-year
Number of events (per 10,000 patients)	DOACs	LMWH	Difference
PE	868	1,058	−190
DVT	877	1,272	−395
ICH	17	42	−25
MB (non-ICH)	682	378	304
CRNMB	1,209	1,033	176
Discontinue	4,402	5,960	−1,558
Death	7,485	7,499	−14
Due to PE	7	7	0
Due to ICH	0	0	0
Due to MB (non-ICH)	7	2	5
Due to other reasons	7,471	7,490	−19
Total cost (USD) per patient	2,232	8,224	−5,992
QALYs per patient	1.52	1.50	0.02

DOACs: direct oral anticoagulants; LMWH: low-molecular-weight heparins; PE: pulmonary embolism; DVT: deep vein thrombosis; ICH: intracranial haemorrhage; MB: major bleeding; CRNMB: clinically relevant non-major bleeding; USD: United States dollars; QALY: quality adjusted life years.

Figure 2. One-way deterministic sensitivity analysis over a 5-year time horizon. LMWH: low-molecular-weight heparins; PE: pulmonary embolism; DOACs: direct oral anticoagulants; ICH: intracranial haemorrhage; MB: major bleeding; DVT: deep vein thrombosis; EV: expected value; ICER: incremental cost-effectiveness ratio; USD: United States dollars; WTP: Willing-To-Pay.

Figure 3. Probabilistic sensitivity analysis over a 5-year time horizon. DOACs: direct oral anticoagulants; LMWH: low-molecular-weight heparins; USD, United States dollars; WTP: Willingness-To-Pay; ICE: Incremental cost-effectiveness. Spots represent 10,000 draws of the probabilistic analysis, and the vertical dotted line represents the WTP limit. Values of blue pentagonal spots on the right side of the WTP line are considered dominant or cost-effective.

Figure 4. Acceptability curves for DOACs and LMWH over a 5-year time horizon. DOACs: direct oral anticoagulants; LMWH: low-molecular-weight heparins; USD, United States dollars; CE: cost-effectiveness.

Data availability statement

All data generated or analysed during this study are included in this published article and its supplementary information files.