Katherine Cain, PharmD, MD Anderson Cancer Center, Houston, TX, discusses results from a study comparing out-of-pocket costs between apixaban and enoxaparin for prevention of postoperative venous thromboembolism (VTE) in patients with gynecologic cancers.
This study was presented at the 2021 Society of Gynecologic Oncology (SGO) Annual Meeting on Women’s Cancer.
Transcript
I'm Katie Cain, a clinical pharmacist at MD Anderson in Houston, Texas. The study that we conducted looked at comparison of out-of-pocket costs between apixaban and enoxaparin for extended postoperative venous thromboembolism prophylaxis in gynecologic oncology patients, and this was presented at the Annual SGO Meeting.
What led to this study is really twofold. First, there had been an increasing amount of data supporting the safety and efficacy of apixaban for extended postoperative VTE prophylaxis, including a study of patients undergoing surgery for gynecologic cancer.
More recently, SGO released a clinical practice statement recommending apixaban be added as an option for extended postoperative VTE prophylaxis.
Second, patient out-of-pocket cost is very important to consider when changing practice. We need to know that the cost of the medication won't be a barrier to patient adherence once they've left the hospital. In 2012, we published a study assessing patient out-of-pocket costs for enoxaparin for VTE prophylaxis and found a high patient adherence rate. We really wouldn't want to change that.
We conducted this study by sending weekly test claims for both apixaban 2.5 mg by mouth twice daily for 28 days and enoxaparin 40 mg subcutaneously daily for 28 days on patients scheduled for open surgery. By doing this, we were able to not only assess patient copay amounts but also able to identify patient prescriptions required a prior authorization.
Upon assessing 86 test claims, we found that the patients prescribed apixaban for extended postoperative VTE prophylaxis may face higher out-of-pocket cost vs enoxaparin. On average, apixaban cost around $74 ranging from $0 to $450 while enoxaparin averaged around $38 ranging from $0 to $260.
Roughly, 6% of the apixaban prescriptions required a prior authorization. Although the same number of enoxaparin prescriptions required a prior authorization, 4 out of 5 of those allowed for a partial fill while prior authorization was being approved.
Adding apixaban to the list of extended postoperative VTE prophylaxis options gives us our first oral option which can be very beneficial for a patient with a needle aversion. However, cost may be more important factor for patients.
Therefore, it's important to consider each patient individually in order to optimize patient adherence. It is also important to be proactive in assessing medication costs to avoid discharge delays.
Cain KE, Harrison R, Marten C, et al. Comparison of out-of-pocket cost between apixaban and enoxaparin for extended-duration venous thromboembolism prophylaxis in gynecologic oncology patients. Presented at: the virtual 2021 SGO Annual Meeting on Women’s Cancer; March 19-25, 2021.
Dr Cain reports no relevant financial relationships.
