Low-dose direct oral anticoagulants (DOACs) may be a cost-effective method for preventing cancer-associated thrombosis among ambulatory patients with cancer, according to research published in Cancer.

Patients with cancer-associated thrombosis not only have a heightened risk of mortality, but also tend to have delays in treatment and higher costs of care. Although there is clinical evidence that DOACs improve survival and quality-adjusted life years (QALYs) in this patient population, no study has previously involved an economic analysis of these therapies to determine cost-effectiveness.

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For this Markov model-based study, researchers “performed a cost-utility analysis comparing low-dose DOACs [with] placebo for the prevention of [cancer-associated thrombosis] in ambulatory patients with cancer,” with the aim of determining cost-effectiveness of this intervention among patients deemed to have intermediate or high risk for cancer-associated thrombosis. A scenario analysis for those determined to be at high risk by Khorana score stratification (a score of 3 or greater) was also conducted.

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Compared with placebo, 6-month thromboprophylaxis with a low-dose DOAC was found to be associated with 32 fewer instances of cancer-associated venous thromboembolism per 1000, as well as 11 fewer major bleeding episodes per 1000, over a patient’s projected lifetime.

Furthermore, the model projected that placebo would be associated with 4.67 QALYs, compared with 4.79 among those receiving DOAC therapy; health care costs were estimated at $8545 and $9899 for placebo and DOAC therapy, respectively. Per patient, this corresponded to an incremental cost-effectiveness ratio of $11,947 per QALY. With a threshold of $50,000 per QALY, low-dose DOAC therapy was determined to be 94% cost-effective in this setting.

Among patients with a Khorana score of at least 3, the incremental cost-effectiveness ratio per QALY was projected to be $5794.

“Thromboprophylaxis with [a] low-dose DOAC…for 6 months appears to be a cost-effective strategy for the prevention of cancer-associated thrombosis in the United States,” the researchers concluded.


1.     Li A, Carlson JJ, Kuderer NM, et al. Cost-effectiveness analysis of low-dose direct oral anticoagulant (DOAC) for the prevention of cancer-associated thrombosis in the United States [published online January 30, 2020]. Cancer. doi:10.1002/cncr.32724