Rivaroxaban More Cost-Effective than Warfarin for Recurrent VTE Prevention

February 2013 Vol 6, No 1, Special Issue
Caroline Helwick

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.

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