title: Rivaroxaban vs. warfarin on extended deep venous thromboembolism treatment: A cost analysis.
abstract: Background Standard treatment for deep venous thromboembolism involves parenteral anticoagulation overlapping with a vitamin K antagonist, an approach that is effective but associated with limitations including the need for frequent coagulation monitoring. The direct oral anticoagulant rivaroxaban is similarly effective to standard therapy as a single-drug treatment for venous thromboembolism and does not require routine coagulation monitoring. The aim of this analysis was to project the long-term costs and outcomes for rivaroxaban compared to standard of care (tinzaparin/warfarin). Methods A total of 184 patients who were under anticoagulant therapy with warfarin or rivaroxaban for extended deep venous thromboembolism were retrospectively evaluated; 59 received rivaroxaban and 125 received warfarin therapy. Assessments were made on age, gender, place of residence, the duration of anticoagulation, mean international normalized ratio value, the effective rate of international normalized ratio (time in the therapeutic range), bleeding-related complication rate, duration of hospitalization due to complications, the number of annual outpatient department admission, cost for drug, cost for hospitalization, cost for outpatient department admission and international normalized ratio measurements. Results The annual outpatient cost is higher in warfarin group (147.09 ± 78 vs. 62.32 ± 19.79 USD p < 0.001). But annual drug cost is higher in rivaroxaban group (362.6 vs. 71.55 ± 31.01 USD p < 0.001). Overall cost of rivaroxaban group is higher than warfarin group (476.25 ± 36.78 vs. 364.82 ± 174.44 USD). Warfarin is not cost-effective when non-drug costs (342.5 ± 174.44 vs. 113.65 ± 36.77) and hospital costs (173.85 ± 122.73 vs. 64.9 ± 23.55 USD) were analyzed. Conclusion This analysis suggests that rivaroxaban has lower costs than warfarin in terms of outpatient department admission and hospital costs due to complications; however, warfarin was more economic when all cost parameters were considered. Time in the therapeutic range was found as 56% for warfarin that should be taken into account while analyzing costs and benefits.
authors.affiliation: 1 Hitit University Faculty of Medicine, Cardiovascular Surgery, Çorum, Turkey.
authors.forename: Adem I
authors.initials: AI
authors.lastname: Diken
authors.affiliation: 1 Hitit University Faculty of Medicine, Cardiovascular Surgery, Çorum, Turkey.
authors.forename: Adnan
authors.initials: A
authors.lastname: Yalçınkaya
authors.affiliation: 2 Ahi Evren Thorax, Heart and Vascular Education and Training Hospital, Cardiovascular Surgery, Trabzon, Turkey.
authors.forename: Muhammet O
authors.initials: MO
authors.lastname: Hanedan
authors.affiliation: 1 Hitit University Faculty of Medicine, Cardiovascular Surgery, Çorum, Turkey.
authors.forename: Mehmet E
authors.initials: ME
authors.lastname: Erol
authors.affiliation: 3 Hitit University Faculty of Medicine, Chest Diseases, Çorum, Turkey.
authors.forename: Özlem
authors.initials: Ö
authors.lastname: Ercen Diken
mesh_terms: D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000191:economics; D000925:Anticoagulants / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D001777:Blood Coagulation / Q000187:drug effects; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D016903:Drug Monitoring / Q000191:economics / Q000379:methods; D065427:Factor Xa Inhibitors / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D005260:Female; D017048:Health Care Costs; D006470:Hemorrhage / Q000139:chemically induced / Q000191:economics; D017721:Hospital Costs; D006801:Humans; D019934:International Normalized Ratio / Q000191:economics; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D012189:Retrospective Studies; D012307:Risk Factors; D000069552:Rivaroxaban / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D013923:Thromboembolism / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics*; D013997:Time Factors; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics*; D014859:Warfarin / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*
chemical_list: D000925:Anticoagulants; D065427:Factor Xa Inhibitors; D014859:Warfarin; D000069552:Rivaroxaban
keywords: Cost–benefit analysis; rivaroxaban; venous thrombosis