Cost-effectiveness of edoxaban for the treatment of venous thromboembolism based on the Hokusai-VTE study

Ronald Preblick, W. Jacqueline Kwong, Richard H White, Samuel Z. Goldhaber

Research output: Contribution to journalArticlepeer-review

16 Scopus citations


OBJECTIVE: Venous thromboembolism (VTE) is associated with almost 300,000 deaths per year in the United States. Novel oral anticoagulants (NOACs) offer an alternative to warfarin-based therapy without monitoring requirements and with fewer drug and food interactions. Edoxaban, a direct Xa inhibitor, is approved by the Food and Drug Administration (FDA), based upon results of the Hokusai-VTE Phase 3 trial. The trial demonstrated that edoxaban administered once daily after initial treatment with heparin was non-inferior in reducing the risk of VTE recurrence and caused significantly less major and clinically relevant non-major (CRNM) bleeding compared to warfarin. The objective of this study was to evaluate the cost-effectiveness of edoxaban versus warfarin for the treatment of adults with VTE.

METHODS: A cost-effectiveness model was developed using patient-level data from the Hokusai-VTE trial, clinical event costs from real-world databases, and drug acquisition costs for warfarin of $0.36 and edoxaban of $9.24 per tablet.

RESULTS: From a U.S. health-care delivery system perspective, the incremental cost-effectiveness ratio (ICER) was $22,057 per quality adjusted life year (QALY) gained. Probabilistic sensitivity analysis showed that edoxaban had an ICER <$50,000 per QALY gained relative to warfarin in 67% of model simulations. The result was robust to variation in key model parameters including the cost and disutility of warfarin monitoring.

CONCLUSION: Despite its higher drug acquisition cost, edoxaban is a cost-effective alternative to warfarin for the treatment of VTE.

Original languageEnglish (US)
Pages (from-to)249-257
Number of pages9
JournalHospital practice (1995)
Issue number5
StatePublished - 2015


  • Cost effectiveness
  • Edoxaban
  • Novel oral anticoagulants
  • Venous thromboembolism
  • Warfarin

ASJC Scopus subject areas

  • Medicine(all)


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