Newly published research out of the University of Cincinnati and the University of California-Davis shows that direct oral anticoagulant (DOAC) drugs are more effective and are more cost-effective than low molecular weight heparin for treating cancer-associated thrombosis.
The research was published in the Annals of Internal Medicine.
"For reasons that are not completely understood, cancer is a pro-thrombotic state. In other words, in cancer patients, their blood clotting system is turned on in a way that makes them more likely to develop blood clots," says Mark Eckman, MD, professor emeritus in the Department of Internal Medicine at the UC College of Medicine, and senior author in the study.
"This is still an area under investigation, but we know from decades of experience and clinical trials that cancer patients are at an increased risk of blood clots. In particular, cancer patients who have already had a blood clot are at even higher risk," Eckman said.
"QALYs are basically years lived by the members of the cohort but adjusted for the quality of life in the different health states they experience over that time," Eckman says. "If you were to have a major bleed for instance, you would have a decrease in your quality of life. In terms of data, one of the advantages of a model like this is that we were able to pull data from multiple sources because it's all not available wrapped up in a neat ribbon in one clinical trial."
Eckman says when discussing such a cost-effectiveness analysis, they are looking not only at the cost of the drug, but also the costs that are accrued or saved because of the drug's efficacy or complication risk.
Another complicating factor in the analysis of the monthly drug cost, he says, is whether the drugs are purchased through a federal facility such as the Veterans Affairs or at a brick-and-mortar or online pharmacy. An individual's insurance coverage plan can make a huge difference in the patient's out-of-pocket costs for these medications.
"Most importantly, all the DOACs are more effective and have a better side-effect profile than low molecular weight heparin," Eckman says. "Which of those is the most cost-effective is going to depend for any given patient on what the cost of those drugs will be for them. That decision can be one that is made in concert with the oncologist and the patient."
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