Health economic evaluation of rivaroxaban in the treatment of patients with chronic coronary artery disease or peripheral artery disease

Cardiovasc Res. 2020 Sep 1;116(11):1918-1924. doi: 10.1093/cvr/cvz278.

Abstract

Aims: In the COMPASS trial, rivaroxaban 2.5 mg twice daily (bid) plus acetylsalicylic acid (ASA) 100 mg once daily (od) performed better than ASA 100 mg od alone in reducing the rate of cardiovascular disease, stroke, or myocardial infarction (MI) in patients with coronary artery disease (CAD) and peripheral artery disease (PAD). A Markov model was developed to assess the cost-effectiveness of rivaroxaban plus ASA vs. ASA alone over a lifetime horizon, from the UK National Health System perspective.

Methods and results: The base case analysis assumed that patients entered the model in the event-free health state, with the possibility to experience ≤2 events, transitioning every three-month cycle, through acute and post-acute health states of MI, ischaemic stroke (IS), or intracranial haemorrhage (ICH), and death. Costs, quality-adjusted life-years (QALYs), life years-all discounted at 3.5%-and incremental cost-effectiveness ratios (ICERs) were calculated. Deterministic and probabilistic sensitivity analyses were conducted, as well as scenario analyses. In the model, patients on rivaroxaban plus ASA lived for an average of 14.0 years with no IS/MI/ICH, and gained 9.7 QALYs at a cost of £13 947, while those receiving ASA alone lived for an average of 12.7 years and gained 9.3 QALYs at a cost of £8126. The ICER was £16 360 per QALY. This treatment was cost-effective in 98% of 5000 iterations at a willingness-to-pay threshold of £30 000 per QALY.

Conclusion: This Markov model suggests that rivaroxaban 2.5 mg bid plus ASA is a cost-effective alternative to ASA alone in patients with chronic CAD or PAD.

Keywords: Coronary artery disease; Cost-effectiveness; Peripheral artery disease; Rivaroxaban.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aspirin / economics
  • Aspirin / therapeutic use
  • Coronary Artery Disease / drug therapy*
  • Coronary Artery Disease / economics*
  • Coronary Artery Disease / mortality
  • Cost-Benefit Analysis
  • Drug Costs*
  • Drug Therapy, Combination
  • Factor Xa Inhibitors / adverse effects
  • Factor Xa Inhibitors / economics*
  • Factor Xa Inhibitors / therapeutic use*
  • Humans
  • Markov Chains
  • Models, Economic
  • Peripheral Arterial Disease / drug therapy*
  • Peripheral Arterial Disease / economics*
  • Peripheral Arterial Disease / mortality
  • Progression-Free Survival
  • Quality of Life
  • Quality-Adjusted Life Years
  • Rivaroxaban / adverse effects
  • Rivaroxaban / economics*
  • Rivaroxaban / therapeutic use*
  • State Medicine / economics
  • Time Factors
  • United Kingdom

Substances

  • Factor Xa Inhibitors
  • Rivaroxaban
  • Aspirin