Predicted Risk of Venous Thromboembolism May Warrant Restarting Anticoagulation

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According to researchers, this study is the first economic model to consider restarting anticoagulation in this patient population.
According to researchers, this study is the first economic model to consider restarting anticoagulation in this patient population.

HealthDay News — Restarting anticoagulation therapy may be cost-effective for patients with a predicted one-year venous thromboembolism (VTE) risk of 17.5% or higher, according to a study published online in the Journal of Thrombosis and Haemostasis.

Mark Monahan, from the University of Birmingham in the United Kingdom, and colleagues examined the long-term cost-effectiveness of using a decision rule for restarting anticoagulation therapy vs no extension of therapy based on a patient's risk of further unprovoked VTE. A Markov patient-level simulation model was developed, which adopted a lifetime time horizon from the perspective of the UK National Health Service/Personal Social Services.

The researchers found that if decision makers are willing to pay up to £20,000 per quality-adjusted life-year gained, treating patients with a predicted one-year VTE risk of 17.5% or higher may be cost-effective. The model was highly sensitive to overall parameter uncertainty, warranting caution in choosing the optimal decision rule on the grounds of cost-effectiveness. Anticoagulation therapy disutility and mortality risks were highly influential for driving the results in univariate sensitivity analyses.

"This represents the first economic model to consider the use of a decision rule for restarting therapy for unprovoked VTE patients," the authors wrote. "Better data are required to predict long-term bleeding risks on therapy in this patient group."

Reference

Monahan M, Ensor J, Moore D, Fitzmaurice D, Jowett S. Economic evaluation of strategies for restarting anticoagulation therapy after a first event of unprovoked venous thromboembolism [published online May 18, 2017]. J Thromb Haemost. doi:10.1111/jth.13739

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