Evidence map›Paper›PMID 36571839›Full record

ArticleAnnals of internal medicine2023

Anticoagulant Therapy for Cancer-Associated Thrombosis : A Cost-Effectiveness Analysis.

Shuchi Gulati, Mark H Eckman

Erratum issuedOpen access · greenAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Annals of internal medicine, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 17 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
17citing papers in PubMed, 3 pooled it
5.2field-weighted citation impact, top 3% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

17 citing papers in PubMed, 3 syntheses or guidelines pooled it, 27 citations in OpenAlex.

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  7. No shots needed: direct oral anticoagulants in cancer-associated thrombosis-10-year follow-up.Hematology. American Society of Hematology. Education Program · 2025
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

2 authors at 2 institutions in 1 country.

Shuchi GulatiDivision of Hematology and Oncology, Department of Medicine, UC Davis Comprehensive Cancer Center, Sacramento, California (S.G.).ORCID 0000-0001-6793-9694
Mark H EckmanUniversity of Cincinnati Medical Center, Cincinnati, and Division of General Internal Medicine, University of Cincinnati, Cincinnati, Ohio (M.H.E.).ORCID 0000-0001-8253-269X
University of California Davis Medical Center · USUniversity of Cincinnati · US

Funding

KL2 Training ProgramKL2TR001426 · NCATS · UNIVERSITY OF CINCINNATI · PI ZELLER, MARGARET H · 2015 to 2024
$6.8M
Combination of Transcriptomic and Metallomic Biomarkers for Risk Assessment in Locoregional Clear Cell Renal Cell CarcinomaK08CA273542 · NCI · UNIVERSITY OF CALIFORNIA AT DAVIS · PI Shuchi Gulati · 2022 to 2026
$1.3M
NCATS NIH HHS KL2 TR001426NCI NIH HHS K08 CA273542
6 · The paper itself

Abstract

backgroundDirect oral anticoagulants (DOACs) offer an alternative to low-molecular-weight heparin (LMWH) and warfarin for treating cancer-associated thrombosis (CAT).

objectiveTo determine the cost and effectiveness of DOACs versus LMWH.

designCohort-state transition decision analytic model. DATA SOURCES: Network meta-analysis comparing DOACs versus LMWH. TARGET POPULATION: Adult patients with cancer at the time they develop thrombosis. TIME HORIZON: Lifetime. PERSPECTIVE: Health care sector.

interventionStrategies of 1) enoxaparin, 2) apixaban, 3) edoxaban, and 4) rivaroxaban for treatment of CAT. OUTCOME MEASURES: Incremental cost-effectiveness ratio (ICER) in 2022 U.S. dollars per quality-adjusted life-year (QALY) gained. RESULTS OF BASE-CASE ANALYSIS: In the base-case scenario, using drug prices from the U.S. Department of Veterans Affairs Federal Supply Schedule, apixaban dominated enoxaparin and edoxaban by being less costly and more effective. Rivaroxaban was slightly more effective than apixaban, with an ICER of $493 246. In a scenario analysis using "real-world" drug prices from GoodRx, rivaroxaban was cost-effective with an ICER of $50 053 per QALY. RESULTS OF SENSITIVITY ANALYSIS: Results were highly sensitive to monthly drug costs. Probabilistic sensitivity analyses showed that at a willingness-to-pay threshold of $50 000 per QALY, apixaban was preferred in 80% of simulations. However, sensitivity analyses also demonstrated that apixaban only remained cost-effective if monthly medication costs were below $530. Above this, rivaroxaban became cost-effective. LIMITATIONS: An assumption was made that patients would continue anticoagulation indefinitely unless they suffered a major bleed. Nonmedical costs such as patient and caregiver loss of productivity were not accounted for, and long-term thrombotic complications were not explicitly modeled.

conclusionThe 3 DOACs are more effective and more cost-effective than LMWH. The most cost-effective DOAC depends on the relative cost of each of these agents. These are important considerations for treating physicians and health policymakers. PRIMARY FUNDING SOURCE: None.

Indexed as

Atrial FibrillationNeoplasmsThrombosisAnticoagulantsCost-Benefit AnalysisCost-Effectiveness AnalysisEnoxaparinHeparin, Low-Molecular-WeightHumansNetwork Meta-Analysis as TopicPyridinesQuality-Adjusted Life YearsRivaroxabanThiazolesAnticoagulantsedoxabanEnoxaparinHeparin, Low-Molecular-WeightPyridinesRivaroxabanThiazoles

Identifiers

PMID36571839
PMCPMC10279520
OpenAlexW4312212217

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.