PCV41 Model Sensitivity Analysis of Venous Thromboembolism Prevention After Total Knee Replacement

Abstract

Cost-effectiveness analysis performed in 2010 showed that the use of rivaroxaban for the prevention of deep vein thrombosis (DVT) and pulmonary embolism (PE) after total knee replacement (TKR) is dominant technology (Vorobiev P. et al. Value in Health, 2011). Objective of this study was to evaluate the cost-effectiveness of rivaroxaban compared to dabigatran and enoxaparin for the prophylaxis of venous thromboembolism in patients after TKR taking into account the recent drug price changes. Cost-effectiveness analysis of rivaroxaban versus dabigatran and enoxaparin to prevent venous thromboembolism after TKR was done in 2010. A decision-tree model of different regimens for thromboprophylaxis after THR was adopted from the model, developed by McCullagh et al. (2009). Total costs and incremental cost-effectiveness ratios (ICERs) were calculated. In 2012 the price of rivaroxaban and dabigatran reduced by 63.8% and 34.6% respectively, while the price of enoxaparin increased by 6.8%. The total cost of rivaroxaban prophylaxis was 4678 €, enoxaparin – 4946 €, dabigatran – 4980 €. To prevent one event of DVT with rivaroxaban the ICER is lower by 2553 € than dabigatran and by 2593 € than enoxaparin. To prevent one event of PE with rivaroxaban the ICER is lower by 268 € than dabigatran and by 307 € than enoxaparin. Sensitivity analysis using new prices confirmed that the use of rivaroxaban for prevention of venous thromboembolism after TKR remains the dominant technology compared to dabigatran and enpxaparin.