Health-care Cost Impact of Continued Anticoagulation With Rivaroxaban vs Aspirin for Prevention of Recurrent Symptomatic VTE in the EINSTEIN-CHOICE Trial Population

Chest: The Journal of Circulation, Respiration and Related Systems

Lloyd Haskell^6¹  Dominique Lejeune^8²  Martin H. Prins^2³  Philip S. Wells^1⁴  Veronica Ashton^9⁵  Bennett Levitan^7⁶  François Laliberté^8⁷  Yongling Xiao^8⁸  Anthonie W.A. Lensing^5⁹  Jan Beyer-Westendorf^3,4^1,10 

[1] Bayer Pharma AG, Wuppertal, Germany^5;Department of Cardiovascular Sciences, University of Padua Medical School, Padua, Italy^10;Department of Epidemiology and Technology Assessment, University of Maastricht, Maastricht, the Netherlands^2;Department of Medicine, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, ON, Canada^1;Groupe d’analyse, Ltée, Montréal, QC, Canada^8;Janssen Research & Development, LLC, Raritan, NJ^6;Janssen Research & Development, LLC, Titusville, NJ^7;Janssen Scientific Affairs, LLC, Titusville, NJ^9;King’s Thrombosis Service, Department of Haematology, King’s College London, London, UK^4;Thrombosis Research Unit, Division of Hematology, Department of Medicine I, University Hospital “Carl Gustav Carus,” Dresden, Germany^3

关键词: anticoagulants;    aspirin;    cost comparison;    economic analysis;    extended treatment;    rivaroxaban;    recurrent VTE;    DOT;    duration of treatment;    EINSTEIN-CHOICE trial;    Reduced-Dose Rivaroxaban in the Long-Term Prevention of Recurrent Symptomatic Venous Thromboembolism;    PE;    pulmonary embolism;    PPPM;    per patient per month;    SLR;    systematic literature review;    WAC;    wholesale acquisition cost;   

DOI  :  10.1016/j.chest.2018.08.1059

学科分类：呼吸医学

来源: American College of Chest Physicians

【 摘 要 】

Background Using data from the Reduced-Dose Rivaroxaban in the Long-Term Prevention of Recurrent Symptomatic Venous Thromboembolism (EINSTEIN-CHOICE) trial, this study assessed cost impact of continued anticoagulation therapy with rivaroxaban vs aspirin. Methods Total health-care costs (2016 USD) associated with rivaroxaban and aspirin were calculated as the sum of clinical event costs and drug costs from a US managed care perspective. Clinical event costs were calculated by multiplying event rate by cost of care. One-year Kaplan-Meier clinical event rates for recurrent pulmonary embolism, recurrent DVT, all-cause mortality, and bleeding were obtained from EINSTEIN-CHOICE. Cost of care was determined by literature review. Drug costs were the product of drug price (wholesale acquisition cost) and treatment duration. A one-way sensitivity analysis was conducted. Results Rivaroxaban users had lower per patient per month (PPPM) clinical event costs compared with aspirin users ($123, $243, and $381 for rivaroxaban 10 mg, rivaroxaban 20 mg, and aspirin, respectively). However, vs aspirin, PPPM total health-care costs were $24 higher for patients treated with rivaroxaban 10 mg ($143 higher for rivaroxaban 20 mg) due to higher cost of rivaroxaban. With a 15% discount for rivaroxaban 10 mg, the lower cost of clinical events for the rivaroxaban-treated patients more than fully offset the higher drug costs, and yielded a $19 lower total health-care cost. Conclusions Continued therapy with rivaroxaban 10 and 20 mg vs aspirin was associated with lower clinical event costs but higher total health-care costs; with a 15% drug discount rivaroxaban 10 mg had lower total health-care costs than aspirin.

【 授权许可】

CC BY