Comprehensive Evaluation Of The Risk And Prevention Of Venous Thrombosis In Cancer Patients Receiving Chemotherapy

Background: Cancer patients with are 4-to 7-fold more likely to develop venous thromboembolism(VTE)than the general population.Recent CASSINI and AVERT trials showed that thromboprophylaxis with new oral anticoagulants(NOACs)is effective and safe in cancer patients initiating chemotherapy.However,the cost-effectiveness of NOACs is unknown.Methods: This study conducted a systematic review and meta-analysis of VTE-related trials based on Khorana scores to report the incidence of VTE in different risk stratified populations.Then,the economic evaluation of preventing VTE with NOACs versus no thromboprophylaxis for cancer patients initiating systemic chemotherapy were compared from the perspective of the Chinese health care system.A decision analytical model consisting of both acute and long-term VTE complications was used to assess the costeffectiveness of thromboprophylaxis with NOACs versus no thromboprophylaxis based on CASSINI and AVERT trials.Costs,qualityadjusted life-years(QALYs)and incremental cost-effectiveness ratios(ICERs) were calculated for the two strategies.Scenario and sensitivity analyses were performed on the basis of different trials and Khorana risk scores.Results: The Meta analyses showed overall incidences of VTE with low,intermediate and high risk of Khorana scores were 4%(95%CI: 1%-10%),11%(95%CI: 8%-15%)and 17%(95%CI: 12%-24%).Compared with no thromboprophylaxis,NOACs gained 0.072 QALY at an incremental cost of$ 930,leading to an ICER of 12,919/QALY in patients with Khorana score ≥2by pooling the data from the CASSINI and AVERT trials.The probability of NOACs being cost-effective was 42% at a willingness to pay of$10,276/QALY.ICERs for patients with low,intermediate,and high VTE risk Khorana scores were $14,104,$12,040,and $8,280 per QALY,respectively.The ICER was sensitive to the relative risks of death and asymptomatic VTE between the two strategies and the cost of NOACs.Conclusions: Thromboprophylaxis with NOACs is not likely to be economically significant in patients initiating chemotherapy in the Chinese context,but it is cost-effective for patients with high VTE risk.The decision about thromboprophylaxis should be tailored based on the survival of cancer patients,the risks of VTE and major bleeding.