OBJECTIVES: To perform a cost-effectiveness analysis of Rivaroxaban (Xarelto®) vs other anticoagulants (Warfarin, Dabigatran and Apixaban) for patients with atrial fibrillation (AF) or deep vein thrombosis (DVP), in the Peruvian public and private sector.

METHODS: Comparative analysis of the costs and effectiveness of treatment with Rivaroxaban and the other molecules. We addressed it through three stages: (i) An econometric model to standardize the occurrence rate of efficacy outcomes (proxy of effectiveness) linked to each molecule in relevant clinical studies (meta-analysis). The results of the efficacy outcomes were standardized as DALY’s to obtain a single measure of effectiveness. (ii) Estimation of Peruvian health cost parameters to address direct (treatment) and indirect costs (loss of productive life generated by the ineffectiveness of the treatment) linked with each molecule in the private and public sector, for the average duration of treatment (14 and 9 months for AF and DVT patients, respectively). And (iii) estimation of the incremental cost-effectiveness ratio (ICER) for each molecule.

RESULTS: Direct Oral Anticoagulants (DOACs), like Rivaroxaban and Apixaban, have lower occurrence rate of thromboembolic events and death than Warfarin; thus, they are more effective. In addition, Rivaroxaban direct costs are the second lowest, after the Warfarin, for all the scenarios, and the lowest for DVT patients in the private sector. Moreover, its indirect costs are the lowest of every treatment in both private and public sector. Hence, Rivaroxaban is highly cost-effective for DVT patients (absolute dominance); and for AF patients, Rivaroxaban is cost-effective because its costs per DALY are below the 1 GDP per capita threshold in the public and private sector.

CONCLUSIONS: In Peru, the use of Rivaroxaban is the most cost-effective alternative for DVT and AF patients in both the public and private sector.