Cost comparison between apixaban and low molecular weight heparin (LMWH) among venous thromboembolism (VTE) patients with cancer

Objective This study evaluated and compared healthcare costs associated with apixaban versus low molecular weight heparin (LMWH) treatment among cancer patients who have venous thromboembolism (VTE).Methods A retrospective database analysis was conducted using IQVIA’s PharMetrics Plus healthcare claims database, from which patients with active cancer newly diagnosed with VTE and who initiated apixaban or LMWH on or within 30 days following the VTE diagnosis were identified. Data from 01 January 2016 through 31 December 2021 were analyzed, including a 12-month baseline and a variable (minimum one month) follow-up period. Stabilized inverse probability treatment weighting (IPTW) was applied to balance patient characteristics between treatment cohorts. All-cause costs were assessed along with recurrent VTE-, major bleeding (MB), and clinically relevant non-major (CRNM) bleeding-related costs. Two-part generalized linear models (GLM) were used to calculate cost ratios for apixaban vs. LMWH, and bootstrapping was implemented to estimate predicted costs. Costs were expressed as per patient per month (PPPM).Results Apixaban was associated with significantly lower predicted mean PPPM all-cause costs compared with the LMWH cohort ($16,408 vs. $21,203, p < 0.0001), with 23% lower PPPM costs versus LMWH (cost ratio: 0.77; 95% confidence interval [CI]: 0.74–0.81). Recurrent VTE-, MB-, and CRNM bleeding-related predicted costs were also lower with apixaban ($713 vs. $1274 [p < 0.0001], $518 vs. $1244 [p < 0.0001], and $733 vs. $980 [p = 0.014], respectively) compared to LMWH.Conclusion Among cancer patients with VTE, apixaban was associated with lower all-cause, recurrent-VTE-, MB-, and CRNM bleeding-related predicted costs compared with LMWH.