Incremental net monetary benefit of direct oral anticoagulants for the prevention of venous thromboembolism after total knee or hip replacement: A systematic review and meta-analysis
Issued Date
2022-08-01
Resource Type
ISSN
00493848
eISSN
18792472
Scopus ID
2-s2.0-85132701711
Pubmed ID
35753113
Journal Title
Thrombosis Research
Volume
216
Start Page
74
End Page
83
Rights Holder(s)
SCOPUS
Bibliographic Citation
Thrombosis Research Vol.216 (2022) , 74-83
Suggested Citation
Veettil S.K., Harris J., Syeed M.S., Thakkinstian A., Chaikledkaew U., Witt D.M., Chaiyakunapruk N. Incremental net monetary benefit of direct oral anticoagulants for the prevention of venous thromboembolism after total knee or hip replacement: A systematic review and meta-analysis. Thrombosis Research Vol.216 (2022) , 74-83. 83. doi:10.1016/j.thromres.2022.06.004 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/85685
Title
Incremental net monetary benefit of direct oral anticoagulants for the prevention of venous thromboembolism after total knee or hip replacement: A systematic review and meta-analysis
Other Contributor(s)
Abstract
Introduction: This meta-analysis was conducted to quantitatively pool the incremental net benefit (INB) of using direct oral anticoagulants (DOACs) for the prevention of venous thromboembolism (VTE) in patients undergoing total knee or hip replacements (TKR or THR). Materials and methods: We performed a comprehensive search in several databases published before June 2021. Studies were included if they were cost-effectiveness analyses reporting cost per quality-adjusted life-year or life-year of DOACs compared to low molecular-weight heparins (LMWHs) or other anticoagulant agents for the prevention of VTE after TKR or THR. Risk of bias was also assessed using the biases in economic studies (ECOBIAS) checklist. Various monetary units were converted to purchasing power parity, adjusted to 2020 US dollars. The INBs were pooled across studies using a random-effects model, stratified by high-income countries (HICs) and low- and middle-income countries (LMICs). Heterogeneity was assessed using the I2 statistic. Results: A total of 49 comparisons (TKR = 25 and THR = 24) from 16 studies was included. In HICs, DOACs were cost-effective compared to LMWHs from the health care system/payer perspective for the prevention of VTE after both TKR and THR with corresponding INBs (95 % CI; I2) of $231.91 ($178.71, $285.11; 0 %) and $254.99 ($159.20, $350.77; 27.79 %), respectively. In LMICs, DOACs were not cost-effective compared to LMWHs for both TKR and THR with the INBs of $94.13 (−$40.21, $228.47; 97.04 %) and $80.55 (−$157.37, $318.47; 99.78 %), respectively. No evidence of small-study effects was identified in any analyses. The cost-effectiveness of using DOACs for TKR and THR in HICs was robust across a series of sensitivity analyses. Conclusions: DOACs were cost-effective as compared to LMWHs for VTE prophylaxis following TKR and THR surgeries in HICs. Further studies from LMICs are warranted.