title: Economic analysis of rivaroxaban for the treatment and long-term prevention of venous thromboembolism in Portugal.
abstract: BACKGROUND
  Venous thromboembolism is a burden on healthcare systems. The aim of this analysis was to project the long-term costs and outcomes for rivaroxaban compared to standard of care (enoxaparin/warfarin) in Portugal for the treatment and secondary prevention of venous thromboembolism.
  
  
  METHODS
  A Markov model was developed using event rates extracted from the EINSTEIN trials supplemented with literature-based estimates of longer-term outcomes. Core outcomes included per patient costs and quality-adjusted life years reported separately per treatment arm and incrementally, as well as cost per quality-adjusted life years gained. The deep vein thrombosis and pulmonary embolism indications were analysed separately. The analyses were conducted from the Portuguese societal perspective and over a 5-year time horizon. Costs and outcomes were discounted at a 5% annual rate. Several scenario analyses were undertaken to explore the impact on results of varying key modeling assumptions.
  
  
  RESULTS
  Rivaroxaban treatment was associated with cost-savings for the treatment of deep vein thrombosis and was both cost-saving and more effective for the treatment of pulmonary embolism, compared with enoxaparin/warfarin.
  
  
  CONCLUSIONS
  The results of the sensitivity and scenario analyses further supported that rivaroxaban is a cost-effective alternative to standard of care treatment. The use of an expert panel to derive some input values and the lack of Portuguese specific utilities were the main limitations.
  
  
  CONCLUSIONS
  Rivaroxaban represents an efficient alternative to using enoxaparin/warfarin in Portugal, as it's associated with lower costs (for both indications) and greater quality adjusted life years (for the pulmonary embolism indication).
authors.affiliation: Bayer Portugal, S.A. Carnaxide. Portugal.
authors.forename: Isabel Fonseca
authors.initials: IF
authors.lastname: Santos
authors.affiliation: Bayer Portugal, S.A. Carnaxide. Portugal.
authors.forename: Sónia
authors.initials: S
authors.lastname: Pereira
authors.affiliation: IMS Health. London. United Kingdom.
authors.forename: Euan
authors.initials: E
authors.lastname: McLeod
authors.affiliation: IMS Health. London. United Kingdom.
authors.forename: Anne-Laure
authors.initials: AL
authors.lastname: Guillermin
authors.affiliation: IMS Health. London. United Kingdom.
authors.forename: Ismini
authors.initials: I
authors.lastname: Chatzitheofilou
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use*; D003365:Costs and Cost Analysis; D017984:Enoxaparin / Q000627:therapeutic use*; D065427:Factor Xa Inhibitors / Q000191:economics* / Q000627:therapeutic use; D006801:Humans; D018803:Models, Economic; D011174:Portugal; D019057:Quality-Adjusted Life Years; D000069552:Rivaroxaban / Q000191:economics* / Q000627:therapeutic use; D013997:Time Factors; D054556:Venous Thromboembolism / Q000188:drug therapy* / Q000517:prevention & control*; D014859:Warfarin / Q000627:therapeutic use*
chemical_list: D000925:Anticoagulants; D017984:Enoxaparin; D065427:Factor Xa Inhibitors; D014859:Warfarin; D000069552:Rivaroxaban