Indefinite Anticoagulant Therapy for First Unprovoked Venous Thromboembolism: A Cost-Effectiveness Study: Annals of Internal Medicine: Vol 176, No 7
Background: Clinical practice guidelines recommend indefinite anticoagulation for a first unprovoked venous thromboembolism (VTE). Objective: To estimate the benefit–harm tradeoffs of indefinite anticoagulation in patients with a first unprovoked VTE. Design: Markov modeling study. Data Sources: Systematic reviews and meta-analyses for the long-term risks and case-fatality rates of recurrent VTE and major bleeding. Published literature for costs, quality of life, and other clinical events. Target Population: Patients with a first unprovoked VTE who have completed 3 to 6 months of initial anticoagulant treatment. Time Horizon: Lifetime. Perspective: Canadian health care public payer. Intervention: Indefinite anticoagulation with direct oral anticoagulants. Outcome Measures: Recurrent VTE events, major bleeding events, costs in 2022 Canadian dollars (CAD), and quality-adjusted life-years (QALYs). Results of Base-Case Analysis: When compared with discontinuing anticoagulation after initia