OBJECTIVES : Rivaroxaban has clinical benefits in the prevention of atherothrombotic events in patients with coronary artery disease (CAD) and/or peripheral artery disease (PAD) based on the results of the COMPASS study. The aim of this study is to understand the cost and clinical benefits of rivaroxaban compared to aspirin from the perspective of reimbursement agency including direct costs and clinical trial outcomes for subgroups in Turkey.

METHODS : A Markov model simulation has been conducted based on the COMPASS study results and published cost data. An expert survey has been conducted for understanding gaps of the cost of each event and health state with 5 experts (3 cardiologists & 2 health economists). Cost of each event and health state has been calculated based on expert survey and Social Security Institution`s reimbursement list. Subgroups have been set as coronary artery disease (CAD), peripheral artery disease (PAD), CAD and PAD, CAD and moderate renal impairment, CAD and Chronic Heart Failure (HF). Time horizon of the model was selected as 30 years. Willingness to pay (WTP) ratio has been accepted as 3 times gross domestic product (GDP) as 145.000 Turkish Lira (TL) depending on World Health Organization`s guideline.

RESULTS : Rivaroxaban has been shown to be cost effective in all subgroups with incremental cost effectiveness ratio (ICER) ranging from 8.888 TL to 130.042 TL per life year as being under WTP ratio. The ICER decreases in subgroups with comorbidities.

CONCLUSIONS : The cost-effectiveness analysis shows that rivaroxaban is cost-effective under the given indications. Decision makers need to consider the study results for achieving better outcomes in CAD and/or PAD patients.