Key result
Continued treatment with rivaroxaban for an additional 6-12 months in VTE patients reduced total healthcare costs by $1,454 compared to placebo (95% CI -$2,396 to $1,231).
Why the study?
Does continued treatment with rivaroxaban reduce total healthcare cost compared to placebo in VTE patients who had completed 6-12 months of initial anticoagulation?
Does continued treatment with rivaroxaban reduce total healthcare cost compared to placebo in VTE patients who had completed 6-12 months of initial anticoagulation?
Continued anticoagulation with rivaroxaban for an additional 6-12 months in VTE patients is estimated to be cost-saving from a US managed care perspective compared to placebo.
Answers are grounded in this paper and cite their sources.
May indicate cost savings with extended rivaroxaban in VTE; leaves open need for prospective confirmation before practice change.
AIMS: The EINSTEIN-Extension trial (EINSTEIN-EXT) found that continued treatment with rivaroxaban for an additional 6 or 12 months (vs placebo) after 6-12 months of initial anticoagulation significantly reduced the risk of recurrent venous thromboembolism (VTE) with a small non-significant increased risk of major bleeding (none fatal or in critical site). This study aimed to compare total healthcare cost between rivaroxaban and placebo, based on the EINSTEIN-EXT event rates. METHODS: Total healthcare cost was calculated as the sum of treatment and clinical event costs from a US managed care perspective. Treatment duration and event rates were obtained from the EINSTEIN-EXT study. Adjustment on treatment duration was made by assuming a 10% non-adherence rate. Drug costs were based on wholesale acquisition costs. Cost estimates for clinical events (i.e. recurrent deep vein thrombosis [DVT], recurrent pulmonary embolism, major bleeding, clinically relevant non-major bleeding) were determined from the literature. Results were examined over a ±20% range of each cost component and over 95% confidence intervals (CIs) of event rate differences in deterministic (one-way) and probabilistic sensitivity analyses (PSA). RESULTS: Total healthcare cost was $1,454 lower for rivaroxaban-treated (vs placebo-treated) patients in the base-case, with a lower clinical event cost fully offsetting drug cost. The cost savings of recurrent DVT alone (-$3,102) was greater than drug cost ($2,723). Total healthcare cost remained lower for rivaroxaban in the majority (73%) of PSA (cost difference [95% CI] = -$1,454 [-$2,396, $1,231]). LIMITATIONS: This study was conducted over the 1-year observation period of the EINSTEIN-EXT trial, which limited "real-world" applicability and examination of long-term economic impact. Assumptions on drug and clinical event costs were US-based and, thus, not applicable to other healthcare systems. CONCLUSIONS: Total healthcare costs were estimated to be lower for patients continuing rivaroxaban therapy compared to those receiving placebo in VTE patients who had completed 6-12 months of VTE treatment.
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Wells et al. (2018) studied Venous thromboembolism (VTE). Rivaroxaban vs. Placebo was evaluated on Total healthcare cost (Cost difference -$1,454, 95% CI -2,396 to 1,231). Continued treatment with rivaroxaban for an additional 6-12 months in VTE patients reduced total healthcare costs by $1,454 compared to placebo (95% CI -$2,396 to $1,231).
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