There is practice variation in the duration of anticoagulation for venous thromboembolism in inflammatory bowel disease (IBD) patients.
Clinicians must weigh the high risk of recurrent venous thromboembolism with the risk of gastrointestinal bleeding.
Dr Geoffrey Nguyen and colleagues from Canada implemented Markov decision analysis to compare the costs and effectiveness of extended anticoagulation vs. time-limited anticoagulation among IBD patients with first unprovoked venous thromboembolism over a 5-year time horizon.
In a secondary analysis, the team added 2 strategies in which therapeutic-dose or prophylactic-dose anticoagulation was administered during IBD flares.
|Extended anticoagulation was cost-effective in 72% of trials|
|American Journal of Gastroenterology|
Compared with time-limited anticoagulation, extended anticoagulation yielded slightly higher quality-adjusted life years (QALYs), and costs, and an incremental cost-effectiveness ratio (ICER) of $15,254/QALY over 5 years.
In secondary analysis, pharmacological prophylaxis during IBD flares was associated with the highest QALYs, and costs, but was not cost-effective when compared with extended anticoagulation.
The team found that anticoagulation during flares yielded the lowest cost, and same QALYs as extended anticoagulation.
In probabilistic sensitivity analysis, extended anticoagulation yielded higher QALYs than time-limited anticoagulation in 91% of trials, and was dominant or cost-effective in 72% of trials.
When analyzed over a lifetime, the researchers found that extended anticoagulation dominated time-limited anticoagulation with higher effectiveness, and lower costs and was highly robust in sensitivity analyses.
Dr Nguyen's team concludes, "Our analyses suggest that extended anticoagulation may provide marginal benefit over time-limited anticoagulation, and should be considered in the management of first unprovoked venous thromboembolism in IBD."
"Anticoagulation and prophylaxis during IBD flares are alternative viable strategies."