Cost-effectiveness analysis of rivaroxaban versus enoxaparin in the treatment of deep venous thrombosis in patients with gynecologic cancer

Abstract

Objective: Deep vein thrombosis (DVT) is one of the main complications in cancer patients with relevant socioeconomic impact. New direct factor X inhibitor oral anticoagulants are being introduced into clinical practice, promising to bring greater ease in their management. However, the clinical protocols do not yet discuss the use of these in cancer patients mainly due to lack of evidence. This article aims to evaluate the cost-effectiveness of rivaroxaban (RVXB) versus enoxaparin (ENOXA) in the treatment of DVT in patients with gynecological cancer. Methods: A cost-effectiveness analysis was performed from the perspective of a federal hospital SUS. From a decision tree model, the effec[1]tiveness and safety outcomes of RVXB and ENOXA in outpatient treatment were considered, with clinical data extracted from a retrospective cohort, and the direct costs obtained from the SIGTAP- -SUS and Ministry of Health. Results: 65 patients were selected and had an average time of seven months of treatment. The cost of treatment with RVXB and ENOXA was R$ 1.172,02 and R$ 7.490,49, respectively, with an incremental cost of R $ 7.789,61 per patient treated with ENOXA. Robustness of the model was tested by deterministic sensitivity analysis in which the resource saving promoted by rivaroxaban was maintained in all variations Conclusion: The RVXB in this context is the dominant technology in the outpatient treatment of patients with gynecological cancer.