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Background <p>Venous thromboembolism (VTE) imposes significant clinical and economic burdens. While direct oral anticoagulants (DOACs) offer favorable efficacy and safety, their cost-effectiveness across diverse VTE etiologies remains incompletely synthesized.</p> Objective <p>To systematically evaluate the cost-effectiveness of DOACs versus comparators for VTE management stratified by etiology.</p> Methods <p>A PRISMA-compliant systematic search was conducted in MEDLINE, Web of Science, Scopus, and NHS EED (2020–2025). Economic evaluations reporting cost-effectiveness or cost-utility outcomes were included. Study quality was assessed using the Drummond checklist.</p> Results <p>Twenty studies were included (9 CAT, 3 post-surgical, 6 hospitalized VTE, 2 COVID-19). DOACs were cost-effective or dominant in 18/20 studies. For cancer-associated thrombosis (CAT), DOACs dominated LMWHs and were cost-effective versus placebo (ICERs: $5,794–$11,947/QALY). DOACs were also dominant for post-surgical prophylaxis and in general hospitalized VTE (ICERs: -$1,862/QALY to $125.68/QALY), while rivaroxaban was cost-effective for post-COVID-19 prophylaxis (ICER: $5,386/QALY).</p> Conclusion <p>DOACs, particularly apixaban and rivaroxaban, are an economically dominant strategy for VTE across most etiologies. Their adoption as a first-line therapy can improve patient outcomes while significantly reducing healthcare costs.</p>

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Economic evaluation of direct oral anticoagulants (DOACs) for venous thromboembolism with different etiologies: a systematic review

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年2月10日

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  • Fereshte Karimi,
  • Soheila Rajaie,
  • Samad Azari,
  • Mohammad Saeid Abbaszadeh,
  • Zeinab Karimi

摘要

Background

Venous thromboembolism (VTE) imposes significant clinical and economic burdens. While direct oral anticoagulants (DOACs) offer favorable efficacy and safety, their cost-effectiveness across diverse VTE etiologies remains incompletely synthesized.

Objective

To systematically evaluate the cost-effectiveness of DOACs versus comparators for VTE management stratified by etiology.

Methods

A PRISMA-compliant systematic search was conducted in MEDLINE, Web of Science, Scopus, and NHS EED (2020–2025). Economic evaluations reporting cost-effectiveness or cost-utility outcomes were included. Study quality was assessed using the Drummond checklist.

Results

Twenty studies were included (9 CAT, 3 post-surgical, 6 hospitalized VTE, 2 COVID-19). DOACs were cost-effective or dominant in 18/20 studies. For cancer-associated thrombosis (CAT), DOACs dominated LMWHs and were cost-effective versus placebo (ICERs: $5,794–$11,947/QALY). DOACs were also dominant for post-surgical prophylaxis and in general hospitalized VTE (ICERs: -$1,862/QALY to $125.68/QALY), while rivaroxaban was cost-effective for post-COVID-19 prophylaxis (ICER: $5,386/QALY).

Conclusion

DOACs, particularly apixaban and rivaroxaban, are an economically dominant strategy for VTE across most etiologies. Their adoption as a first-line therapy can improve patient outcomes while significantly reducing healthcare costs.