Background: Venous thromboembolism (VTE) in hospitalized medically ill patients is a leading preventable cause of morbidity and mortality in the United States. About half of VTE events occur following discontinuation of standard-duration in-hospital prophylaxis and hospital discharge. The APEX study evaluated Betrixaban for in-hospital to home VTE prophylaxis and is the first FDA approved anticoagulant for in-hospital and extended-duration (35-42 days) prophylaxis of VTE in adult patients hospitalized for an acute medical illness who are at risk for thromboembolic complications due to moderate or severe restricted mobility and other risk factors for VTE. The goal of this analysis was to quantify the economic benefits of betrixaban over an extended 35-42 day duration compared to standard-duration enoxaparin for an acute-care hospital.
Methods: We developed a dynamic, Excel-based model to estimate the budget impact of extended-duration VTE prophylaxis. VTE-related readmission and fatal or irreversible event rates were calculated from published APEX sub-studies. Duration of therapy was based on the median APEX hospital duration of 5 days. Betrixaban number needed to treat (NNT) was calculated from 80mg mITT sub-population composite endpoints in APEX. Cost of clinical events were identified through peer-reviewed literature and extrapolated to $2017 using the CPI medical inflation index.
Results: Assuming an institution has 20,000 acute hospitalizations per year, 3,923 patients would be non-surgical patients at ACCP-defined high VTE risk. Including those patients at risk consistent with APEX, 2,458 patients would potentially be eligible for betrixaban. A betrixaban strategy would lead to 17 fewer VTE-related and 36 fewer fatal or irreversible readmissions compared to standard-duration enoxaparin. Applying the betrixaban WAC price and APEX NNTs, the cost to prevent a symptomatic event with betrixaban is $10,207 and $4,422 for a fatal or irreversible event. These costs are significantly lower than the costs to treat a non-fatal PE, symptomatic DVT, ICH, ischemic stroke or MI.
Conclusions: Inclusion of a betrixaban strategy may lead to fewer 30-day readmissions, which could potentially decrease acute-care institution Hospital Readmission Reduction Program CMS penalties. Institution HCAHPS summary star ratings, which factor both 30-day readmission rates and patient satisfaction scores, may improve based on eliminating limitations of enoxaparin such as injection discomfort and bruising and decreased compliance/missed doses.