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01.12.2015 | Original basic research | Ausgabe 1/2015 Open Access

Thrombosis Journal 1/2015

Cost-effectiveness analysis of treatment of venous thromboembolism with rivaroxaban compared with combined low molecular weight heparin/vitamin K antagonist

Zeitschrift:
Thrombosis Journal > Ausgabe 1/2015
Autoren:
Luke Bamber, Dominic Muston, Euan McLeod, Anne Guillermin, Julia Lowin, Raj Patel
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​s12959-015-0051-3) contains supplementary material, which is available to authorized users.

Competing interests

LB and DM are employees of Bayer. RP has received lecture fees and has participated in advisory boards for Bayer. EM, AG and JL were full-time employees of IMS Health during development of this work and have worked as paid consultants to Bayer Pharma AG. The authors declare that they have no other competing interests.

Authors’ contributions

EM, AG and JL carried out the analyses. EM, LB, DM and RP contributed to the interpretation of the results and the drafting of the manuscript. All authors read and approved the final manuscript.

Abstract

Background

Venous thromboembolism (VTE) is a burden on healthcare systems. Standard treatment involves parenteral anticoagulation overlapping with a vitamin K antagonist, an approach that is effective but associated with limitations including the need for frequent coagulation monitoring. The direct oral anticoagulant rivaroxaban is similarly effective to standard therapy as a single-drug treatment for VTE and does not require routine coagulation monitoring. The objective of this economic evaluation was to estimate the cost-effectiveness of rivaroxaban compared with standard VTE treatment from a UK perspective.

Methods

A Markov model was constructed using data and probabilities derived from the EINSTEIN DVT and EINSTEIN PE studies of rivaroxaban and other published sources. Health outcomes included VTE rates, bleeding events avoided, quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs).

Results

There was greater discounted quality-adjusted life expectancy with rivaroxaban than with standard therapy, irrespective of indication and treatment duration. Rivaroxaban was associated with per-patient cost savings for each treatment duration modelled (3, 6 and 12 months), and these were greatest with shorter durations. Rivaroxaban was found to be dominant (cheaper and more effective) and, therefore, cost-effective, in both patients with deep vein thrombosis and pulmonary embolism in all three treatment duration groups, and was also cost-effective in patients requiring lifelong anticoagulation (ICERs: £8677 per QALY and £7072 per QALY in patients with index deep vein thrombosis and pulmonary embolism, respectively). The cost-effectiveness of rivaroxaban was largely insensitive to variations in one-way sensitivity analysis. Probabilistic sensitivity analysis demonstrated that at a threshold of £20,000 per QALY, rivaroxaban had a consistent probability of being cost-effective, compared with LMWH/VKA treatment, of around 80% regardless of index VTE or duration of anticoagulation therapy (3, 6, 12 months or lifelong).

Conclusions

This analysis suggests that rivaroxaban represents a cost-effective choice for acute treatment of deep vein thrombosis and pulmonary embolism and secondary prevention of VTE in the UK, compared with LMWH/VKA treatment, regardless of the required treatment duration.
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