Budget impact analysis of betrixaban for venous thromboembolism prophylaxis in nonsurgical patients with acute medical illness in the United Kingdom

Expert Rev Pharmacoecon Outcomes Res. 2020 Jun;20(3):259-267. doi: 10.1080/14737167.2019.1629905. Epub 2019 Jun 19.


Objectives: Venous thromboembolism (VTE) incurs substantial costs to the UK National Health Service (NHS). Betrixaban is approved in the US for VTE prophylaxis with a recommended 35-42 days of treatment. This analysis modeled the budget impact of introducing betrixaban for extended-duration VTE prophylaxis in nonsurgical patients with acute medical illness at risk of VTE in the UK, where it is not yet licensed.

Methods: The 5-year budget impact of introducing betrixaban into current prophylaxis (low molecular weight heparin and fondaparinux) was estimated for the UK NHS. The Phase 3 APEX study provided primary event (VTE, myocardial infarction, ischemic stroke, and death; all-cause or VTE-related) and treatment complications data. Literature informed risk of recurrent events and long-term complications, population, market share, and costs for treatment and management of events. Network meta-analyses informed symptomatic DVT, pulmonary embolism and VTE-related death rates in fondaparinux patients. Deterministic sensitivity analyses explored uncertainty.

Results: Introducing betrixaban accrued savings of £1,290,000-£23,000,000 in years 1-5. Savings were from reduced primary VTE events, which reduced recurrent events and future complications. All sensitivity analyses showed savings.

Conclusion: Introducing extended-duration VTE prophylaxis with betrixaban in the UK would accrue substantial savings annually over the next 5 years compared to current prophylaxis. Clinical trial registration: www.clinicaltrials.gov identifier is NCT01583218.

Keywords: Betrixaban; UK; budget impact; prophylaxis; venous thromboembolism.

Publication types

  • Clinical Trial, Phase III
  • Comparative Study

MeSH terms

  • Acute Disease
  • Adult
  • Aged
  • Benzamides / economics
  • Benzamides / therapeutic use*
  • Budgets*
  • Cost Savings
  • Factor Xa Inhibitors / economics
  • Factor Xa Inhibitors / therapeutic use*
  • Humans
  • Middle Aged
  • Models, Economic
  • Pyridines / economics
  • Pyridines / therapeutic use*
  • Risk Factors
  • State Medicine
  • Time Factors
  • United Kingdom
  • Venous Thromboembolism / economics
  • Venous Thromboembolism / prevention & control*


  • Benzamides
  • Factor Xa Inhibitors
  • Pyridines
  • betrixaban

Associated data

  • ClinicalTrials.gov/NCT01583218