title: The economic implications of switching to rivaroxaban from enoxaparin plus vitamin K antagonist in the treatment of venous thromboembolism.
abstract: OBJECTIVE
  Venous thromboembolism (VTE) impacts ∼900,000 individuals annually in the US, causing up to 100,000 deaths. Patients experiencing VTE have heightened risk of recurrence. Initial parenteral anti-coagulation is standard therapy for acute VTE followed by ≥3 months of warfarin, which introduces the risk of major bleeding. Balancing increased risks of bleeding and recurrent VTE remains challenging. Recent clinical trials suggest that rivaroxaban, an oral direct inhibitor of factor Xa, provides an effective, safe, simplified approach to treatment. This study considers the economic implications of these data.
  
  
  METHODS
  This study modeled inpatient, acute, and 1-year VTE costs for a hypothetical commercial plan with 1 million members. At baseline, all VTE patients receive standard therapy. Alternatively, 25% are instead treated with rivaroxaban. Model inputs are trial- and literature-based.
  
  
  RESULTS
  Standard therapy for VTE consumes 9474 inpatient days ($31.6 million). Added to that is treatment for 74 recurrences ($1.4 million); major and non-major bleed events ($1 million); and direct costs of anti-coagulation ($5.3 million). Alternatively, a 25% shift to oral anti-coagulation with rivaroxaban reduces inpatient days (by 5%); associated acute-care costs (by 2%); recurrences and costs (by 6%). Four major bleeding events are prevented, at the cost of one additional non-major bleeding event, which, taken together, reduce net utilization by 9%. Direct costs of anti-coagulation increase by 5%.
  
  
  CONCLUSIONS
  The reduction in inpatient utilization, recurrences, and major bleeding resulting from a 25% shift from standard therapy to rivaroxaban following acute VTE would conserve ∼$860,475 for every 1 million commercial health plan enrollees.
authors.affiliation: Janssen Scientific Affairs, LLC , Raritan, NJ , USA.
authors.forename: Aarti A
authors.initials: AA
authors.lastname: Patel
authors.forename: Kristine
authors.initials: K
authors.lastname: Ogden
authors.forename: Samir H
authors.initials: SH
authors.lastname: Mody
authors.forename: Brahim
authors.initials: B
authors.lastname: Bookhart
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D004359:Drug Therapy, Combination; D017984:Enoxaparin / Q000191:economics* / Q000627:therapeutic use*; D006470:Hemorrhage / Q000191:economics; D006760:Hospitalization / Q000191:economics; D006801:Humans; D017059:Models, Econometric; D011655:Pulmonary Embolism / Q000188:drug therapy* / Q000517:prevention & control; D012008:Recurrence; D000069552:Rivaroxaban / Q000191:economics* / Q000627:therapeutic use*; D014481:United States; D054556:Venous Thromboembolism / Q000188:drug therapy* / Q000517:prevention & control; D014812:Vitamin K / Q000037:antagonists & inhibitors
chemical_list: D000925:Anticoagulants; D017984:Enoxaparin; D014812:Vitamin K; D000069552:Rivaroxaban
keywords: Burden of illness; Cost analysis; Deep vein thrombosis; Pulmonary embolism; Rivaroxaban; Standard therapy; Venous thromboembolism