Cost-effectiveness of rivaroxaban compared with enoxaparin plus a vitamin K antagonist for the treatment of venous thromboembolism.
J Med Econ. 2013 Oct 25;
Authors: Lefebvre P, Coleman CI, Bookhart BK, Wang ST, Mody SH, Tran KN, Zhuo DY, Huynh L, Nutescu EA
Abstract Background: Venous thromboembolism (VTE), comprised of deep vein thrombosis (DVT) and pulmonary embolism (PE), is commonly treated with a low-molecular-weight heparin such as enoxaparin plus a vitamin K antagonist (VKA) to prevent recurrence. Administration of enoxaparin+VKA is hampered by complexities of laboratory monitoring and frequent dose adjustments. Rivaroxaban, an orally administered anticoagulant, has been compared with enoxaparin+VKA in the EINSTEIN trials. The objective was to evaluate the cost-effectiveness of rivaroxaban compared with enoxaparin+VKA as anticoagulation treatment for acute, symptomatic, objectively-confirmed DVT or PE. Methods: A Markov model was built to evaluate the costs, quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios associated with rivaroxaban compared to enoxaparin+VKA in adult patients treated for acute DVT or PE. All patients entered the model in the "on-treatment" state upon commencement of oral rivaroxaban or enoxaparin+VKA for 3, 6, or 12 months. Transition probabilities were obtained from the EINSTEIN trials during treatment and published literature after treatment. A 3-month cycle length, US payer perspective ($2012), 5-year time horizon and a 3% annual discount rate were used. Results: Treatment with rivaroxaban cost $2,448 per-patient less and was associated with 0.0058 more QALYs compared with enoxaparin+VKA, making it a dominant economic strategy. Upon one-way sensitivity analysis, the model's results were sensitive to the reduction in index VTE hospitalization length-of-stay associated with rivaroxaban compared with enoxaparin+VKA. At a willingness-to-pay threshold of $50,000/QALY, probabilistic sensitivity analysis showed rivaroxaban to be cost-effective compared with enoxaparin+VKA approximately 76% of the time. Limitations: The model did not account for the benefits associated with an oral and minimally invasive administration of rivaroxaban. "Real-world" applicability is limited because data from the EINSTEIN trials were used in the model. Also, resource utilization and costs were based on the US healthcare system. Conclusion: Rivaroxaban is a cost-effective option for anticoagulation treatment of acute VTE patients.
PMID: 24156243 [PubMed - as supplied by publisher]