Cost comparison of continued anticoagulation with rivaroxaban versus placebo based on the one-year EINSTEIN-Extension trial efficacy and safety results.
J Med Econ. 2018 Feb 22;:1-16
Authors: Wells PS, Lensing AWA, Haskell L, Levitan B, Laliberté F, Durkin M, Ashton V, Xiao Y, Crivera C, Lejeune D, Schein J, Lefebvre P
AIMS: The EINSTEIN-Extension trial (EINSTEIN-EXT) found that continued treatment with rivaroxaban for an additional 6 or 12 months (versus placebo) after 6-12 months of initial anticoagulation significantly reduced the risk of recurrent venous thromboembolism (VTE) with a small non-significant increased risk of major bleeding (none fatal or in critical site). This study aimed to compare total healthcare cost between rivaroxaban and placebo based on the EINSTEIN-EXT event rates.
METHODS: Total healthcare cost was calculated as sum of treatment and clinical event costs from a US managed care perspective. Treatment duration and event rates were obtained from the EINSTEIN-EXT study. Adjustment on treatment duration was made by assuming a 10% non-adherence rate. Drug costs were based on wholesale acquisition costs. Cost estimates for clinical events (i.e., recurrent deep vein thrombosis [DVT], recurrent pulmonary embolism, major bleeding, clinically relevant non-major bleeding) were determined from the literature. Results were examined over a ±20% range of each cost component and over 95% confidence intervals (CIs) of event rate differences in deterministic (one-way) and probabilistic sensitivity analyses (PSA).
RESULTS: Total healthcare cost was $1,454 lower for rivaroxaban-treated (versus placebo-treated) patients in the base-case, with a lower clinical event cost fully offsetting drug cost. The cost savings of recurrent DVT alone (-$3,102) was greater than drug cost ($2,723). Total healthcare cost remained lower for rivaroxaban in the majority (73%) of PSA (cost difference [95% CI]: -$1,454[-$2,396, $1,231]).
LIMITATIONS: This study was conducted over the one-year observation period of the EINSTEIN-EXT trial, which limited "real-world" applicability and examination of long-term economic impact. Assumptions on drug and clinical event costs were US-based and thus not applicable to other healthcare systems.
CONCLUSIONS: Total healthcare costs were estimated to be lower for patients continuing rivaroxaban therapy compared to those receiving placebo in VTE patients who had completed 6 to 12 months of VTE treatment.
PMID: 29469638 [PubMed - as supplied by publisher]