PCV6 Cost-Effectiveness and Budget Impact Analysis of Rivaroxaban in the Prevention of Thromboembolic Events in Patients Performing Hip and Knee Arthroplasty in Comparison With Enoxaparin Under the Brazilian Private Health Care System Perspective

Abstract

To develop a cost-effectiveness and a budget impact analysis of Rivaroxaban in the prevention of thromboembolic events in patients performing hip and knee arthroplasty in comparison with Enoxaparin under the Brazilian private health care system perspective. A decision tree analysis was developed for the first 90 days, considering the occurrence of Deep Venous Thrombosis, Pulmonary Embolism and thromboembolic events, followed by a Markov model, for Post Thrombotic Syndrome and Thrombotic Pulmonary Hypertension. The time horizon of the analysis was 5 year. The cycle duration was 1 year and corresponding epidemiological and efficacy data were obtained from a critical appraisal of the scientific literature. The outcomes were expressed as the incremental number of all thromboembolic events. The analysis considered only direct medical costs. Unit costs for drugs, procedures, materials and daily hospital were obtained from Kairos Magazine (Maximum price consumers 18% ICMS), Hierarchical Brazilian Classification of Medical Procedures (CBHPM 5thedition), Simpro Magazine (Maximum price consumers 18%ICMS) and UNIDAS 2008, respectively. A budget impact analysis was developed considering an increase of 10% per year in market share of Rivaroxaban. Total costs associated with Rivaroxaban and Enoxaparin, considering the indication for knee arthroplasty, were BRL363 (US$214) and BRL632 (US$372), respectively. Rivaroxaban reduces the number of all thromboembolic events in 0.0167. Rivaroxaban treatment is more effective and cheaper than Enoxaparin treatment (dominant). Total costs associated with Rivaroxaban and Enoxaparin, considering the indication for hip arthroplasty, were BRL332 (US$195) and BRL468 (US$275), respectively. The number of all thromboembolic events was the same. Rivaroxaban treatment is cheaper with same efficacy. The budget impact analysis estimated an economy of BRL98,810 (US$58,124) and BRL184,630 (US$108,606) for knee and hip indication, respectively, in 5 years. By this pharmacoeconomic analysis, the treatment with Rivaroxaban, shown to reduce treatment costs and events compared with Enoxaparin.