Li A, Carlson JJ, Kuderer NM, et al. - In view of the randomized controlled trials (RCTs) describing the possible utility of low-dose DOACs, including rivaroxaban and apixaban, for reducing the incidence of cancer-associated venous thromboembolism (VTE), researchers conducted this cost-utility analysis from the health sector perspective employing a Markov state-transition model in patients with cancer who are at intermediate-to-high risk for VTE. A meta-analysis of the RCTs and relevant epidemiology studies provided data concerning transition probability, relative risk, cost, and utility inputs. Low-dose DOAC thromboprophylaxis for 6 months vs placebo resulted in 32 per 1,000 fewer VTE and 11 per 1,000 more major bleeding episodes over a lifetime among patients with cancer at intermediate-to-high risk for VTE. The incremental cost and quality-adjusted life-year (QALY) gains were $1,445 and 0.12, respectively, with an incremental cost-effectiveness ratio (ICER) of $11,947 per QALY increase. The relative risks of VTE and bleeding and drug cost were the key drivers of ICER variations. At the threshold of $50,000 per QALY, this strategy was estimated to be 94% cost-effective. The analysis thereby suggests that for these patients, low-dose DOAC thromboprophylaxis for 6 months is cost-effective. The highest cost-benefit ratio may be obtained with the implementation of this strategy in patients with Khorana scores ≥ 3.