OBJECTIVES

: In the COMPASS trial, rivaroxaban 2.5 mg twice daily plus acetylsalicylic acid (ASA) 100mg once daily performed better than ASA 100mg once daily in reducing the rate of cardiovascular death, stroke, or myocardial infarction (MI) in patients with coronary artery disease (CAD) and peripheral artery disease (PAD). A Markov model was built to assess the cost-effectiveness of rivaroxaban plus ASA vs ASA alone over a lifetime horizon, using a UK National Health System perspective.

METHODS

: The base case analysis assumed patients entered the model in the event-free health state, with the possibility to experience ≤2 events, transitioning every three-month cycle, through acute and post-acute health states of MI, ischaemic stroke (IS), or intracranial haemorrhage (ICH), and death. Costs, quality-adjusted life years (QALYs), life years (LYs), all discounted at 3.5%, and incremental cost-effectiveness ratios (ICERs) were calculated. Deterministic and probabilistic sensitivity analyses, as well as scenario analyses, were conducted to estimate the impact of assumptions on the results.

RESULTS

: Patients on rivaroxaban plus ASA lived an average of 14.0 years with no IS/MI/ICH, and accumulated 9.7 QALYs at a cost of £13,947. Patients receiving ASA alone lived 12.7 years and accumulated 9.3 QALYs at a cost of £8,126. The ICER was £16,360 per QALY gained and 14,380 per LY saved. Exploratory sensitivity and scenario analyses suggested that the model was robust to changes in the majority of input parameters. Rivaroxaban plus ASA was cost-effective in 98% (respectively 75%) of 5,000 iterations at the willingness-to-pay threshold of £30,000 (respectively £20,000) per QALY gained.

CONCLUSIONS

: This Markov model suggests that rivaroxaban 2.5 mg twice daily plus ASA is a cost-effective alternative to ASA alone in patients with CAD or PAD.