Monahan, M, Ensor, J ORCID: 0000-0001-7481-0282, Moore, D, Fitzmaurice, D and Jowett, S (2017) Economic evaluation of strategies for restarting anticoagulation therapy with warfarin based on Venous Thromboembolism (VTE) risk after an index unprovoked VTE event. Journal of Thrombosis and Haemostasis, 15 (8). pp. 1591-1600. ISSN 1538-7836

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Abstract

Background
Following at least 3 months of anticoagulation therapy after a first unprovoked venous thromboembolism (VTE), there is uncertainty about the duration of therapy. Further anticoagulation therapy reduces the risk of having a potentially fatal recurrent VTE but at the expense of a higher risk of bleeding, which can also be fatal.

Objective
An economic evaluation sought to estimate the long‐term cost‐effectiveness of using a decision rule for restarting anticoagulation therapy vs. no extension of therapy in patients based on their risk of a further unprovoked VTE.

Methods
A Markov patient‐level simulation model was developed, which adopted a lifetime time horizon with monthly time cycles and was from a UK National Health Service (NHS)/Personal Social Services (PSS) perspective.

Results
Base‐case model results suggest that treating patients with a predicted 1 year VTE risk of 17.5% or higher may be cost‐effective if decision makers are willing to pay up to £20 000 per quality adjusted life year (QALY) gained. However, probabilistic sensitivity analysis shows that the model was highly sensitive to overall parameter uncertainty and caution is warranted in selecting the optimal decision rule on cost‐effectiveness grounds. Univariate sensitivity analyses indicate variables such as anticoagulation therapy disutility and mortality risks were very influential in driving model results.

Conclusion
This represents the first economic model to consider the use of a decision rule for restarting therapy for unprovoked VTE patients. Better data are required to predict long‐term bleeding risks during therapy in this patient group.

Item Type: Article
Additional Information: This is the accepted author manuscript (AAM). The final published version (version of record) is available online via Wiley at http://dx.doi.org/10.1111/jth.13739 - please refer to any applicable terms of use of the publisher.
Uncontrolled Keywords: Deep Vein Thrombosis, Pulmonary Embolism, Cost-Benefit Analysis, Medical Economics, Venous Thromboembolism
Subjects: R Medicine > RC Internal medicine > RC666 Diseases of the circulatory (Cardiovascular) system
Divisions: Faculty of Medicine and Health Sciences > Primary Care Health Sciences
Depositing User: Symplectic
Date Deposited: 08 May 2017 08:40
Last Modified: 13 Aug 2018 10:38
URI: http://eprints.keele.ac.uk/id/eprint/3363

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