In a randomized trial (i.e. CLOT) which evaluated extended duration prophylaxis of recurrent VTE in cancer patients (Lee et al, 2003), dalteparin reduced the relative risk of recurrent VTE by 52% compared to oral VKA therapy (P = 0.002). A recent subgroup analysis in patients with moderate to severe renal impairment at randomization also revealed lower absolute VTE rates with dalteparin (3% vs. 17%; p = 0.011). A patient level pharmacoeconomic analysis was conducted to evaluate these indications from the French, Austrian and Dutch health care system perspectives.
Resource utilization data contained within the database was extracted and converted into direct cost estimates for each country. Univariate analysis was used to compare the total cost of therapy between patients randomized to dalteparin or VKA therapy for each country. To estimate the cost per quality adjusted life year (QALY) gained with dalteparin, health state utilities were measured in 24 members of the general public using the Time Trade-Off technique.
When all of the cost components were combined for the entire population (n = 676), the dalteparin group had significantly higher mean overall costs than the VKA group in each of the respective countries (Table). However, the preference assessment revealed that 21 of 24 respondents (88%) selected dalteparin over VKA with an associated gain of 0.14 (95%CI: 0.10 – 0.18) QALYs, resulting in favourable cost effectiveness ratios.
|Country*||Dalteparin||VKA||Cost / QALY|
|France||€2,267 (80)||€1,352 (94)||€6,600|
|Austria||€2,687 (81)||€2,012 (102)||€4,900|
|Netherlands||€2,376 (81)||€1,724 (102)||€4,697|
Extended duration prophylaxis with dalteparin is a clinically and cost effective alternative to VKA for the prevention of recurrent VTEs in patients with cancer, especially in those with renal impairment.
Clinical trial identification
Legal entity responsible for the study
L. Shane: Employed by the sponsor; Pfizer Inc. G. Dranitsaris: Consultant to Pfizer Inc. S. Woodruff, B. Valtier, L. Burgers: Employed by Pfizer Inc. All other authors have declared no conflicts of interest.