title: Cost-effectiveness Analysis of Rivaroxaban in the Secondary Prevention of Acute Coronary Syndromes in Sweden.
abstract: BACKGROUND
  Worldwide, coronary heart disease accounts for 7 million deaths each year. In Sweden, acute coronary syndrome (ACS) is a leading cause of hospitalization and is responsible for 1 in 4 deaths.
  
  
  OBJECTIVE
  The aim of this analysis was to assess the cost-effectiveness of rivaroxaban 2.5 mg twice daily (BID) in combination with standard antiplatelet therapy (ST-APT) versus ST-APT alone, for the secondary prevention of ACS in adult patients with elevated cardiac biomarkers without a prior history of stroke/transient ischemic attack (TIA), from a Swedish societal perspective, based on clinical data from the global ATLAS ACS 2-TIMI 51 trial, literature-based quality of life data and costs sourced from Swedish national databases.
  
  
  METHODS
  A Markov model was developed to capture rates of single and multiple myocardial infarction (MI), ischemic and hemorrhagic stroke, thrombolysis in myocardial infarction (TIMI) major, minor, and "requiring medical attention" bleeds, revascularization events, and associated costs and utilities in patients who were stabilized after an initial ACS event. Efficacy and safety data for the first 2 years came from the ATLAS ACS 2-TIMI 51 trial. Long-term probabilities were extrapolated using safety and effectiveness of acetylsalicylic acid data, which was estimated from published literature, assuming constant rates in time. Future cost and effects were discounted at 3.0%. Univariate and probabilistic sensitivity analyses were conducted.
  
  
  RESULTS
  In the base case, the use of rivaroxaban 2.5 mg BID was associated with improvements in survival and quality-adjusted life years (QALYs), yielding an incremental cost per QALY of 71,246 Swedish Krona (SEK) (€8045). The outcomes were robust to changes in inputs. The probabilistic sensitivity analysis demonstrated rivaroxaban 2.5 mg BID to be cost-effective in >99.9% of cases, assuming a willingness-to-pay threshold of SEK 500,000 (€56,458).
  
  
  CONCLUSIONS
  Compared with ST-APT alone, the use of rivaroxaban 2.5 mg BID in combination with ST-APT can be considered a cost-effective treatment option for ACS patients with elevated cardiac biomarkers without a prior history of stroke/TIA in Sweden.
  
  
  BACKGROUND
  Bayer Pharma AG.
authors.affiliation: Pharmerit Ltd, Enterprise House, Innovation Way, Heslington, York, YO10 5NQ, UK.
authors.forename: Najida
authors.initials: N
authors.lastname: Begum
authors.affiliation: Pharmerit Ltd, Enterprise House, Innovation Way, Heslington, York, YO10 5NQ, UK. sstephens@pharmerit.com.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Stephens
authors.affiliation: Pharmerit GmbH, Berlin, Germany.
authors.forename: Olaf
authors.initials: O
authors.lastname: Schoeman
authors.affiliation: Bayer AB, Solna, Sweden.
authors.forename: Anina
authors.initials: A
authors.lastname: Fraschke
authors.affiliation: Bayer Pharma AG, Berlin, Germany.
authors.forename: Bodo
authors.initials: B
authors.lastname: Kirsch
authors.affiliation: Bayer Pharma AG, Berlin, Germany.
authors.forename: Jean-Baptiste
authors.initials: JB
authors.lastname: Briere
authors.affiliation: University Medical Center St. Radboud, Nijmegen, The Netherlands.
authors.forename: Freek W A
authors.initials: FW
authors.lastname: Verheugt
authors.affiliation: Pharmerit Ltd, Enterprise House, Innovation Way, Heslington, York, YO10 5NQ, UK.|University of Sheffield, School of Health and Related Research, Sheffield, UK.
authors.forename: Ben A
authors.initials: BA
authors.lastname: van Hout
keywords: Acute coronary syndrome; Antiplatelet; Antithrombotic; Cost-effectiveness; Rivaroxaban; Secondary prevention