Healthcare Cost Impact of Continued Anticoagulation with Rivaroxaban versus Aspirin for Prevention of Recurrent Symptomatic Venous Thromboembolism in the EINSTEIN-CHOICE Trial Population.
Chest. 2018 Sep 07;:
Authors: Wells PS, Prins MH, Beyer-Westendorf J, Lensing AW, Haskell L, Levitan B, Laliberté F, Ashton V, Xiao Y, Lejeune D, Crivera C, Lefebvre P, Zhao Q, Yuan Z, Schein J, Prandoni P
BACKGROUND: Using data from the Reduced-dosed Rivaroxaban in the Long-term Prevention of Recurrent Symptomatic Venous Thromboembolism (EINSTEIN-CHOICE) trial, this study assessed cost impact of continued anticoagulation therapy with rivaroxaban vs. aspirin.
METHODS: Total healthcare costs (2016USD) associated with rivaroxaban and aspirin were calculated as the sum of clinical event costs and drug costs from a US managed care perspective. Clinical event costs were calculated by multiplying event rate by cost of care. One-year Kaplan-Meier clinical event rates for recurrent pulmonary embolism, recurrent deep-vein thrombosis, all-cause mortality, and bleeding were obtained from EINSTEIN-CHOICE. Cost of care was determined by literature review. Drug costs were the product of drug price (wholesale acquisition cost) and treatment duration. A one-way sensitivity analysis was conducted.
RESULTS: Rivaroxaban users had lower per patient per month (PPPM) clinical event costs compared with aspirin users ($123, $ 243, and $381 for rivaroxaban 10mg, rivaroxaban 20mg, and aspirin, respectively). However, vs. aspirin, PPPM total healthcare costs were $24 higher for rivaroxaban 10mg treated patients ($143 higher for rivaroxaban 20mg) due to higher cost of rivaroxaban. With a 15% discount for rivaroxaban 10mg, the lower cost of clinical events for the rivaroxaban-treated patients more than fully offset the higher drug costs, and yielded a $19 lower total healthcare cost.
CONCLUSIONS: Continued therapy with rivaroxaban 10mg and 20mg vs. aspirin was associated with lower clinical event costs but higher total healthcare costs; with a 15% drug discount rivaroxaban 10mg had lower total healthcare costs than aspirin.
PMID: 30201406 [PubMed - as supplied by publisher]