Abstract
BackgroundVenous 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.MethodsA 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).ResultsThere 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).ConclusionsThis 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.Electronic supplementary materialThe online version of this article (doi:10.1186/s12959-015-0051-3) contains supplementary material, which is available to authorized users.
Highlights
Venous thromboembolism (VTE) is a burden on healthcare systems
Venous thromboembolism (VTE) is both an acute, potentially life-threatening and chronic condition that continues to present a burden to healthcare systems [1,2,3]
Current standard of care consists of initial treatment with a parenteral anticoagulant, often low molecular weight heparin (LMWH; administered by subcutaneous injection) overlapping with a vitamin K antagonist (VKA), typically warfarin [11,12,13]
Summary
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 effective to standard therapy as a single-drug treatment for VTE and does not require routine coagulation monitoring. Long-term sequelae of VTE include recurrent thromboembolism, post-thrombotic syndrome (PTS) and chronic thromboembolic pulmonary hypertension (CTEPH) [8,9]. These serious complications further add to the burden of managing VTE [10]. LMWHs are associated with safety issues, when used without careful individualized dosing [22], and patients with poor dexterity may experience difficulties with subcutaneous self-administration
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