OBJECTIVES : Many individuals with coronary (CAD) or peripheral artery disease (PAD) experience cardiovascular events (CVE) irrespective of acetylsalicylic acid (ASA) use. Thus, improvements to the secondary prevention of CVE are needed. We evaluated the cost-effectiveness of CAD/PAD treatments in the secondary prevention of CVEs and applied Patients-Interventions-Comparator-Outcomes-Setting-Time-Effects-Perspective-Sensitivity analysis (PICOSTEPS) structural reporting framework.

METHODS : Myocardial infarction, ischaemic stroke, haemorrhagic stroke, acute limb ischaemia, amputation, major non-fatal extracranial bleed and various CVE-related and other reasons for death were included in a Markov model setting among a cohort consisting of stable CAD or symptomatic PAD patients. Effects of interventions in the secondary prevention of CVEs were incorporated from COMPASS trial. Primary outcome was 3% per year discounted incremental cost-effectiveness ratio (ICER), given as year 2019 payer cost per quality-adjusted life-year (QALY) gained in Finnish setting over lifetime horizon. Effects covered Finnish mortality, health-related quality of life and direct costs from health care payer perspective. Costs per life-year gained (LYG), cost-effectiveness tables and acceptability frontiers (CEAF) were the secondary outcomes. Probabilistic and deterministic sensitivity analyses were done.

RESULTS : In comparison to ASA, rivaroxaban resulted to the highest modelled amount of discounted QALYs gained (0.395) and LYGs (0.469) among the interventions, and its modelled average additional costs were €1,229. Rivaroxaban had an ICER of €4,742/QALY versus ASA (€3,114/QALY in probabilistic analysis). Rivaroxaban had 98% probability of cost-effectiveness with the very plausible willingness-to-pay of €25,254/QALY gained. The primary result was robust based on the sensitivity analyses.

CONCLUSIONS : Rivaroxaban was cost-effective in modelled comparisons among stable CAD or symptomatic PAD patients. Starting from July 2019, rivaroxaban is also reimbursed as restricted in the respective indication in Finland.