Rivaroxaban More Cost-Effective than Warfarin in the Prevention of Recurrent VTE

Caroline Helwick

January 2013, Vol 4, No 1 - ASH Annual Meeting

For the prevention of recurrent venous thromboembolism (VTE), rivaroxaban (Xarelto) appears to be more cost-effective than warfarin (Coumadin), an independent analysis undertaken by the University of Pittsburgh School of Medicine showed.

“These results demonstrate that, based on best-available evidence, prophylactic anticoagulation with rivarox­aban appears to be a cost-effective, and perhaps cost-saving, alternative to warfarin,” said Craig D. Seaman, MD, a hematology/oncology fellow with the University of Pittsburgh Medical Center. “In sensitivity analyses, our results are highly robust over a wide range of values for all of the important parameters.”

Rivaroxaban is a once-daily oral anticoagulant that is an alternative to standard vitamin K antagonists and low-molecular-weight heparin for the treatment and prevention of VTE.

The study was a base-case analysis that consisted of a hypothetical cohort of 60-year-old patients who were diagnosed with an initial VTE, for which they received secondary prophylaxis with rivaroxaban or with warfarin for 6 months.

The model assumed a base-case value of $39 per dose for warfarin; $205 per dose for rivaroxaban; $8652 per a major bleeding event; $15,493 per intracranial hemorrhage; and $19,938 per intensive care unit stay. The quality-of-life values and probabilities for bleeding and death were part of the model.

The sensitivity analysis showed that the total cost for a base case was $3195 for rivaroxaban and $6188 for warfarin; quality-adjusted life-years (QALYs) were 9.29 and 9.14, respectively; and cost-effectiveness ratios were $344 and $677, respectively. Warfarin dominated in the incremental cost-effectiveness ratio.

In probabilistic sensitivity analysis, there was a 97.5% likelihood that rivaroxaban would be considered cost-effective using a willingness-to-pay threshold of $100,000 per QALY gained, Dr Seaman added.