Cost effectiveness of Rivaroxaban versus low molecular weight heparin and vitamin K antagonists for the treatment of deep-vein thrombosis in the Belgian healthcare setting

Objectives: The aim of the present study was to evaluate the cost-effectiveness of rivaroxaban versus current standard of care for the acute treatment of deep-vein thrombosis (DVT) and prevention of recurrent DVT and pulmonary embolism (PE) in the Belgian healthcare setting. Background: The mainstay of therapy for venous thromboembolism has been low-molecular-weight heparin (LMWH) for the initial treatment followed by oral vitamin K antagonists (VKAs) for the continued treatment during 3 to 12 months. VKAs are both effective and inexpensive, but require monitoring and carry a risk of bleeding. Rivaroxaban is the first novel oral anticoagulant that received approval for treating VTE, but there are few data on the cost-effectiveness of rivaroxaban versus LMWH/VKA. Methods: A Markov model was designed and populated with: 1) local cost estimates, 2) comparative 2 year clinical data from the EINSTEIN-DVT phase III trial comparing rivaroxaban with LMWH / VKA and 3) data from medical literature. The results are extrapolated to a total time horizon of 40 years. Results: Rivaroxaban was the dominant treatment option for patients requiring three months or six months treatment and cost-effective (€1,905 per QALY) for patients requiring twelve months of therapy. Sensitivity analyses showed these results were robust across a wide range of data input values. Conclusions: The results of the present cost-effectiveness analysis indicate that rivaroxaban provides a dominant or at least a cost-effective treatment alternative to LMWH/VKA for the treatment of DVT and prevention of recurrent DVT and PE in Belgium

Cost-effectiveness of rivaroxaban versus warfarin for stroke prevention in atrial fibrillation in the Belgian healthcare setting

Warfarin, an inexpensive drug that has been available for over half a century, has been the mainstay of anticoagulant therapy for stroke prevention in patients with atrial fibrillation (AF). Recently, rivaroxaban, a novel oral anticoagulant (NOAC) which offers some distinct advantages over warfarin, the standard of care in a world without NOACs, has been introduced and is now recommended by international guidelines. The aim of this study was to evaluate, from a Belgian healthcare payer perspective, the cost-effectiveness of rivaroxaban versus use of warfarin for the treatment of patients with non-valvular AF at moderate to high risk. A Markov model was designed and populated with local cost estimates, safety-on-treatment clinical results from the pivotal phase III ROCKET AF trial and utility values obtained from the literature. Rivaroxaban treatment was associated with fewer ischemic strokes and systemic embolisms (0.308 vs. 0.321 events), intracranial bleeds (0.048 vs. 0.063), and myocardial infarctions (0.082 vs. 0.095) per patient compared with warfarin. Over a lifetime time horizon, rivaroxaban led to a reduction of 0.042 life-threatening events per patient, and increases of 0.111 life-years and 0.094 quality-adjusted life-years (QALYs) versus warfarin treatment. This resulted in an incremental cost-effectiveness ratio of a,not sign8,809 per QALY or a,not sign7,493 per life-year gained. These results are based on valuated data from 2010. Sensitivity analysis indicated that these results were robust and that rivaroxaban is cost-effective compared with warfarin in 87 % of cases should a willingness-to-pay threshold of a,not sign35,000/QALY gained be considered. The present analysis suggests that rivaroxaban is a cost-effective alternative to warfarin therapy for the prevention of stroke in patients with AF in the Belgian healthcare setting