title: Cost-effectiveness of rivaroxaban compared with enoxaparin plus a vitamin K antagonist for the treatment of venous thromboembolism.
abstract: BACKGROUND
  Venous thromboembolism (VTE), comprised of deep vein thrombosis (DVT) and pulmonary embolism (PE), is commonly treated with a low-molecular-weight heparin such as enoxaparin plus a vitamin K antagonist (VKA) to prevent recurrence. Administration of enoxaparin + VKA is hampered by complexities of laboratory monitoring and frequent dose adjustments. Rivaroxaban, an orally administered anticoagulant, has been compared with enoxaparin + VKA in the EINSTEIN trials. The objective was to evaluate the cost-effectiveness of rivaroxaban compared with enoxaparin + VKA as anticoagulation treatment for acute, symptomatic, objectively-confirmed DVT or PE.
  
  
  METHODS
  A Markov model was built to evaluate the costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios associated with rivaroxaban compared to enoxaparin + VKA in adult patients treated for acute DVT or PE. All patients entered the model in the 'on-treatment' state upon commencement of oral rivaroxaban or enoxaparin + VKA for 3, 6, or 12 months. Transition probabilities were obtained from the EINSTEIN trials during treatment and published literature after treatment. A 3-month cycle length, US payer perspective ($2012), 5-year time horizon and a 3% annual discount rate were used.
  
  
  RESULTS
  Treatment with rivaroxaban cost $2,448 per-patient less and was associated with 0.0058 more QALYs compared with enoxaparin + VKA, making it a dominant economic strategy. Upon one-way sensitivity analysis, the model's results were sensitive to the reduction in index VTE hospitalization length-of-stay associated with rivaroxaban compared with enoxaparin + VKA. At a willingness-to-pay threshold of $50,000/QALY, probabilistic sensitivity analysis showed rivaroxaban to be cost-effective compared with enoxaparin + VKA approximately 76% of the time.
  
  
  CONCLUSIONS
  The model did not account for the benefits associated with an oral and minimally invasive administration of rivaroxaban. 'Real-world' applicability is limited because data from the EINSTEIN trials were used in the model. Also, resource utilization and costs were based on the US healthcare system.
  
  
  CONCLUSIONS
  Rivaroxaban is a cost-effective option for anticoagulation treatment of acute VTE patients.
authors.affiliation: Groupe d'analyse , Ltée, Montréal, Québec , Canada.
authors.forename: Patrick
authors.initials: P
authors.lastname: Lefebvre
authors.forename: Craig I
authors.initials: CI
authors.lastname: Coleman
authors.forename: Brahim K
authors.initials: BK
authors.lastname: Bookhart
authors.forename: Si-Tien
authors.initials: ST
authors.lastname: Wang
authors.forename: Samir H
authors.initials: SH
authors.lastname: Mody
authors.forename: Kevin N
authors.initials: KN
authors.lastname: Tran
authors.forename: Daisy Y
authors.initials: DY
authors.lastname: Zhuo
authors.forename: Lynn
authors.initials: L
authors.lastname: Huynh
authors.forename: Edith A
authors.initials: EA
authors.lastname: Nutescu
mesh_terms: D000925:Anticoagulants / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D004359:Drug Therapy, Combination / Q000191:economics; D017984:Enoxaparin / Q000191:economics* / Q000627:therapeutic use; D006801:Humans; D008390:Markov Chains; D008875:Middle Aged; D009025:Morpholines / Q000191:economics* / Q000627:therapeutic use; D019057:Quality-Adjusted Life Years; D000069552:Rivaroxaban; D013876:Thiophenes / Q000191:economics* / Q000627:therapeutic use; D014481:United States / Q000453:epidemiology; D020246:Venous Thrombosis / Q000401:mortality / Q000517:prevention & control*; D014812:Vitamin K / Q000191:economics* / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D017984:Enoxaparin; D009025:Morpholines; D013876:Thiophenes; D014812:Vitamin K; D000069552:Rivaroxaban