OBJECTIVES: Direct oral anticoagulants and low-molecular weight heparins have demonstrated to be effective in preventing or treating cancer-associated thrombosis (CAT), but they also interfere with hemostasis leading to an increased risk of bleeding and decreased adherence. As a result, many patients with CAT do not receive adequate treatment in terms of dose and/or duration, which can lead to less favorable outcomes. This early economic analysis explored the potential cost-effectiveness of a hypothetical new therapy for the treatment of CAT from a UK perspective.

METHODS: A Markov model was developed to reflect the clinical pathways typical of patients with CAT. Use of a hypothetical new treatment was compared with apixaban and dalteparin. Treatment discontinuation for apixaban and dalteparin was informed by real-world discontinuation rates. A plausible range of bleeding risk for the new treatment was assessed. Total costs and quality-adjusted life years over a lifetime were compared.

RESULTS: Compared to apixaban, a new treatment that reduced the risk of bleeding by at least 23% was cost-effective at a £30k/QALY threshold assuming a monthly cost that is 20% higher than apixaban, the same risk for venous thromboembolisms, and a 30% lower discontinuation rate. Considering a range between 0.5-0.7 for the relative risk of bleeding versus apixaban, the new treatment remained cost-effective with a monthly cost up to 28-53% higher than apixaban. The new treatment dominated dalteparin in all scenarios explored.

CONCLUSIONS: An effective treatment that reduces the risk of bleeding and offers improved adherence is a potentially cost-effective treatment option for patients with CAT. The model results suggest that a treatment with these characteristics could both improve outcomes in patients with CAT while also demonstrating economic value.