Cost-Effectiveness of Rivaroxaban and Acetylsalicylic Acid Combination Therapy in Stable Cardiovascular Disease: A Global Perspective

OBJECTIVES: The Cardiovascular Outcomes for People Using Anticoagulation Strategies (COMPASS) trial demonstrated a significant reduction in the risk of major adverse cardiovascular events with the combination of rivaroxaban (2.5 mg twice daily) and acetylsalicylic acid (ASA) (100 mg once daily) compared to ASA alone in managing stable cardiovascular disease. Given the findings of the COMPASS trial and the significant healthcare burden of cardiovascular disease, this review aims to summarize the published evidence on the cost-effectiveness of rivaroxaban (2.5 mg twice daily) plus ASA versus ASA alone (100 mg once daily) in the context of stable cardiovascular disease on a global scale.

METHODS: On February 9, 2024, we conducted a PubMed search using the terms "rivaroxaban AND acetylsalicylic acid AND cost-effectiveness". This search yielded 39 manuscripts. Applying our pre-specified inclusion criteria based on the COMPASS population, intervention, and comparator characteristics, we included nine manuscripts in our review. Data extraction was performed manually.

RESULTS: The included cost-effectiveness analyses (CEAs) reflect perspectives from various national healthcare payers, including Italy, the Netherlands, France, Germany, United Kingdom, Australia, USA, Canada, China, and Taiwan. Markov model was the central modelling strategy in all studies. Overall, these CEAs indicate that the combined regimen of low-dose rivaroxaban plus ASA is cost-effective compared to ASA alone for the prevention of recurrent cardiovascular events in patients with coronary artery disease and peripheral artery disease. Incremental cost-effectiveness ratios varied from USD$3946 per QALY gained in Canada to €32,109 per QALY gained in the Netherlands; all below accepted willingness to pay thresholds. Notably, only the CEA from Taiwan diverged in its conclusion.

CONCLUSIONS: Prescribing low-dose rivaroxaban in addition to ASA for patients with stable cardiovascular disease is cost-effective. These pharmacoeconomic findings provide valuable insights for managing patients with stable cardiovascular disease, potentially impacting policy and informing clinical strategies and guidelines.