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).
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.
Effect estimate: Cost difference -$1,454 (95% CI -2,396 to 1,231)
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.
Wells et al. (Thu,) conducted a other in 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).