COST-EFFECTIVENESS OF VENOUS THROMBOEMBOLISM PROPHYLAXIS AFTER TOTAL KNEE AND HIP REPLACEMENT FROM THE BRAZILIAN PRIVATE HEALTHCARE SYSTEM PERSPECTIVE

OBJECTIVES: To access the cost-effectiveness of apixaban versus other anticoagulants in the venous thromboembolism (VTE) prophylaxis after total knee (TKR) and hip (THR) replacement in the Brazilian private healthcare system (PHS). METHODS: A cost-effectiveness analysis of apixaban versus other anticoagulants (dabigatran, rivaroxaban, warfarin and enoxaparin) was performed using a Markov-associated decision tree model that followed patients who had undergone TKR and THR (56% of the cohort underwent THR) over a 12-month time horizon. The clinical outcome considered was life years saved (LY). The economic outcome considered was medical direct costs, considering an annual discount rate of 5%. A probabilistic sensitivity analysis (PSA) was also performed, considering variations in efficacy, risks of long-term events and costs. The costeffectiveness acceptability curve ranged from BRL 0 to 100,000. RESULTS: Total costs of enoxaparin, dabigatran, rivaroxaban, apixaban and warfarin were, respectively, BRL 881, BRL 463, BRL 383, BRL 348 e BRL 292, with effectiveness of 1.18 LY for all treatments. In the ASP, the efficiency of all treatments had little variation because of the low incidence of thromboembolic events or bleeding. The acceptability curve indicated a 100% probability in apixaban to be more costeffective versus all comparators, except for warfarin, regardless of willingness to pay. CONCLUSIONS: It was possible to observe similar efficacy among all anticoagulants for VTE prophylaxis after TKR and THR, with apixaban being the treatment with the lowest cost, that is, more efficient compared to all comparators, but not to warfarin, in the Brazilian PHS.