Cost-effectiveness analysis of low-molecular-weight heparin versus aspirin thromboprophylaxis in patients newly diagnosed with multiple myeloma

• In newly diagnosed multiple myeloma, heparin is not better than low-dose aspirin to prevent thromboembolism.
• Low-molecular weight heparin strategy has the disadvantage of being more expensive than low-dose aspirin strategy.
• The used of low-dose aspirin provided benefit for quality of life.
• Societies guidelines recommending thromboprophylaxis in multiple myeloma should be revisited in the light of these findings

IntroductionThe aim of this study was to assess the cost-effectiveness of low molecular weight heparin versus aspirin as primary thromboprophylaxis throughout chemotherapy for newly diagnosed multiple myeloma patients treated with protocols including thalidomide from the perspective of French health care providers.MethodsWe used a modeling approach combining data from the only randomized trial evaluating the efficacy of the two treatments and secondary sources for costs, and utility values. We performed a decision-tree analysis and our base case was a hypothetical cohort of 10,000 patients. A bootstrap resampling technique was used. The incremental cost-effectiveness ratio was calculated using estimated quality-adjusted life years as the efficacy outcome. Incremental costs and effectiveness were estimated for each strategy and the incremental cost-effectiveness ratio was calculated. One-way sensitivity analyses were performed.ResultsThe number of quality-adjusted life years was estimated to be 0.300 with aspirin and 0.299 with heparin. The estimated gain with aspirin was therefore approximately one day. Over 6 months, the mean total cost was € 1518 (SD = 601) per patient in the heparin arm and € 273 (SD = 1019) in the aspirin arm. This resulted in an incremental cost of € 1245 per patient treated with heparin. The incremental cost-effectiveness ratio for the aspirin versus heparin strategy was calculated to be – 687,398 € (95% CI, − 13,457,369 to − 225,385).ConclusionsAspirin rather than heparin thromboprophylaxis, during the first six months of chemotherapy for myeloma, is associated with significant cost savings per patient and also with an unexpected slight increase in quality of life.