Venous thromboembolic events (VTEs) include both deep vein thrombosis (DVT) and pulmonary embolism (PE). VTEs represent an important disease burden in Canada; they are common and likely to increase as the population ages. The standard of care for patients diagnosed with DVT and/or PE has been systemic anticoagulation with heparin (low-molecular-weight heparin [LMWH], administered subcutaneously), followed by oral administration of vitamin K antagonists (VKAs). Recently, direct oral anticoagulants (DOACs) have been developed as an alternative treatment for VTEs.
In order to inform policy work and clinical decisions on the use of DOACs for the treatment of VTEs, a health technology assessment (HTA) was undertaken. For this project, CADTH worked in partnership with the Canadian Collaboration for Drug Safety, Effectiveness and Network Meta-Analysis (ccNMA), which is funded by the Drug Safety and Effectiveness Network (DSEN) of the Canadian Institutes of Health Research (CIHR). The HTA includes both a clinical and an economic evaluation. The clinical component was conducted by ccNMA, and the economic evaluation was conducted by CADTH. Findings from the economic evaluation are presented in this report; the results of the clinical evaluation are available at: https://www.ottawaheart.ca/researchers/resources-services/core-facilities/cardiovascular-research-methods-centre.
The objective of the economic evaluation is to determine the incremental cost-effectiveness of DOACs (rivaroxaban, apixaban, edoxaban, dabigatran) compared with standard of care (LMWH followed by oral VKA) for the treatment of patients who are newly diagnosed with DVT and/or PE within the Canadian health care system. Various durations of therapy (three months, six months, and lifelong) are examined in the economic report. For lifelong treatment, VKAs were also compared with acetylsalicylic acid (ASA).