P1616 - Cost-Effectiveness of Venous Thromboembolism Prophylaxis After Hospitalization in Patients With Inflammatory Bowel Disease

Kate E. Lee, BA¹, Francesca Lim, MS², Jean-Frederic Colombel, MD³, Chin Hur, MD, MPH², Adam S. Faye, MD, MS^4
1Columbia University College of Physicians and Surgeons, New York, NY; ²Columbia University Medical Center, New York, NY; ³Icahn School of Medicine at Mount Sinai, New York, NY; ⁴New York University School of Medicine, New York, NY

Introduction: Patients with inflammatory bowel disease (IBD) have a 2- to 3-fold greater risk of venous thromboembolism (VTE) than the general population, with increased risk during hospitalization. However, recent evidence suggests that this increased risk persists post-discharge. As such, we aimed to determine the cost-effectiveness of post-discharge VTE prophylaxis among hospitalized patients with IBD.

Methods: A decision tree was used to compare inpatient prophylaxis alone versus 4 weeks of post-discharge VTE prophylaxis with rivaroxaban 10 mg/day. Our primary outcome was quality-adjusted life years (QALYs) over one year, and strategies were compared using a willingness to pay of $100,000/QALY from a societal perspective. Costs (in 2020 $US), incremental cost-effectiveness ratios (ICERs), and number needed to treat (NNT) to prevent one VTE and VTE death were calculated. Deterministic 1-way and probabilistic analyses were performed to assess uncertainty within the model.

Results: Four-week post-discharge prophylaxis with rivaroxaban resulted in 1.68 higher QALYs per 1000 persons and an incremental cost of $185,778 per QALY as compared to no post-discharge prophylaxis (see Table). The NNT to prevent a single VTE was 78 individuals, while the NNT to prevent a single VTE-related death was 3190 individuals. One-way sensitivity analyses showed that higher baseline VTE risk >4.5% or decreased cost of rivaroxaban ≤$280 can reduce the ICER to < $100,000/QALY (see Figure, Tornado Diagram showing main drivers of the ICER). Probabilistic sensitivity analyses favored post-discharge prophylaxis in 30.5% of iterations.

Discussion: Four weeks of post-discharge VTE prophylaxis results in higher QALYs as compared to inpatient prophylaxis alone, and can prevent one post-discharge VTE among 78 patients with IBD. As such, post-discharge VTE prophylaxis in patients with IBD should be considered in a case-by-case scenario considering VTE risk profile, costs, and patient preference.


Figure: Figure. Tornado diagram showing main drivers (variables and sensitivity ranges) of the incremental cost-effectiveness ratio (ICER).
* Values represent threshold values that reduce the ICER to < $100,000/QALY.
Abbreviations: VTE (Venous Thromboembolism), DVT (Deep Vein Thrombosis), PE (Pulmonary Embolism), PTS (Post-Thrombotic Syndrome), WTP (Willingness To Pay), EV (Expected Value)

	Post-discharge VTE prophylaxis	No post-discharge VTE prophylaxis
Cost (in 2020 $US)	$690.39	$377.45
Incremental cost	$312.94	-
Effectiveness (QALYs)	0.99773	0.99604
Incremental effectiveness	1.68 QALYs per 1000 persons	-
ICER	$185,778/QALY	-
NNT to prevent one VTE	78 patients	-
NNT to prevent one VTE-related death	3190 patients	-

Table: Table. Cost-effectiveness analysis results.
Abbreviations: QALY (Quality-Adjusted Life Years), ICER (Incremental Cost-Effectiveness Ratio), NNT (Number Needed to Treat), VTE (Venous Thromboembolism)


Disclosures:
Kate Lee indicated no relevant financial relationships.
Francesca Lim indicated no relevant financial relationships.
Jean-Frederic Colombel: AbbVie – Consultant, Grant/Research Support, lectures. Allergan – Other Financial or Material Support, lectures. Amgen – Consultant, Other Financial or Material Support, lectures. Arena Pharmaceuticals – Consultant. Boehringer Ingelheim – Consultant. Celgene Corporation – Consultant. Celltrion – Consultant. Eli Lilly – Consultant. Entasis Therapeutics Inc – Consultant. Enterome – Consultant. Ferring Pharmaceuticals – Consultant, Other Financial or Material Support, lectures. Galmed Research – Consultant. Genentech – Consultant. Geneva – Consultant. Genfit – Stockholder/Ownership Interest (excluding diversified mutual funds). Glaxo Smith Kline – Consultant. Imedex – Consultant. Immunic – Consultant. Inotrem – Consultant. Intestinal Biotech Development – Stockholder/Ownership Interest (excluding diversified mutual funds). Ipsen – Consultant. Iterative Scopes – Consultant. Janssen Pharmaceuticals – Consultant, Grant/Research Support. Landos – Consultant. LimmaTech Biologics AG – Consultant. lmtbio – Consultant. Medimmune – Consultant. Merck – Consultant. Novartis – Consultant. O Mass – Consultant. Ostuka – Consultant. PBM Capital – Consultant. Pfizer – Consultant. Sanofi – Consultant. SERENE CD – Consultant. Shire – Consultant, Other Financial or Material Support, lectures. Takeda – Consultant, Grant/Research Support, Other Financial or Material Support, lectures. TiGenix – Consultant. Viela bio – Consultant. Vifor – Consultant.
Chin Hur indicated no relevant financial relationships.
Adam Faye indicated no relevant financial relationships.


Kate E. Lee, BA¹, Francesca Lim, MS², Jean-Frederic Colombel, MD³, Chin Hur, MD, MPH², Adam S. Faye, MD, MS⁴. P1616 - Cost-Effectiveness of Venous Thromboembolism Prophylaxis After Hospitalization in Patients With Inflammatory Bowel Disease, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.