Are direct oral anticoagulants an economically attractive alternative to low molecular weight heparins in lung cancer as
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Are direct oral anticoagulants an economically attractive alternative to low molecular weight heparins in lung cancer associated venous thromboembolism management? Jennifer Howlett1,2 · Eric Benzenine2,4 · Philippe Fagnoni3,5 · Catherine Quantin2,4,6
© Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Venous thromboembolism is highly prevalent in lung cancer patients. Low molecular weight heparins are recommended for long term treatment of cancer associated venous thromboembolism. Direct oral anticoagulants are however an interesting alternative as they are administered orally and don’t require monitoring. There are currently studies comparing both their efficacy and tolerance for cancer patients and more and more guidelines suggest considering direct oral anticoagulants for cancer associated venous thromboembolism treatment. The objective of this study was to evaluate the budgetary impact that direct oral anticoagulants use would have for lung cancer associated venous thromboembolism treatment and prevention in France. An economic model was made to evaluate the cost of venous thromboembolism treatment and prevention among patients with primary lung cancer in France by two strategies: current guidelines versus direct oral anticoagulants use. The model was fed with clinical and economic data extracted from the French national health information system. The analysis was conducted from the national mandatory Health insurance point of view. The time horizon of the study was the evaluation of the annual management cost. Lung cancer associated venous thromboembolism management’s mean cost was estimated of 836€ per patient, that is a total cost of about 40 million euros per year at a national level. A 76% decrease of this cost can be expected with direct oral anticoagulants use. However, despite their benefits, these treatments raise new issues (medication interactions, bleeding management), and would likely not be recommended for all patients. Keywords Lung cancer · Venous thromboembolism · Anticoagulant therapy · Direct oral anticoagulant · Economic impact
Highlights
* Catherine Quantin catherine.quantin@chu‑dijon.fr 1
Pharmacy, Quimper Hospital, 14 avenue Yves Thepot, 29000 QUIMPER, France
2
Biostatistics and Bioinformatics (DIM), University Hospital, Bourgogne Franche-Comté University, Dijon, France
3
Pharmacy, Bourgogne Franche-Comté University Hospital, Dijon, France
4
INSERM CIC 1432; Clinical Epidemiology/Clinical Trials Unit, Clinical Investigation Center, Dijon University Hospital, Dijon, France
5
Unité INSERM U866, University Hospital, Dijon, France
6
Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), INSERM, UVSQ, Institut Pasteur, Université Paris-Saclay, Paris, France
• Direct oral anticoagulants are an attractive alternative to
low molecular weight heparins.
• Lung cancer associated venous thromboembolism’s costs
were estimated at 836€ per patient.
• A decrease up to 76% of this cost can be expected with
direct or
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