OBJECTIVES : COMPASS study showed that low-dose rivaroxaban plus aspirin were more efficacious than aspirin alone in the treatment of stable cardiovascular diseases (CVDs), but the cost-effectiveness has been a concern. Hence, this study aimed to investigate the cost-effectiveness of low-dose rivaroxaban plus aspirin for the patients with stable CVDs from the Taiwanese national payer’s perspective.

METHODS : We constructed a Markov model to project the lifetime direct medical costs and quality-adjusted life years (QALYs) of low-dose rivaroxaban plus aspirin and aspirin alone. Transitional probabilities were derived from COMPASS study, while costs and utilities were obtained from Taiwan National Health Insurance database and published studies. One-way, scenario and probabilistic sensitivity analyses (PSA) were performed to evaluate the uncertainty, and the incremental cost-effectiveness ratio (ICER) value was presented as our outcome. Threshold of willingness-to-pay (WTP) was set at USD $20,000 and $60,000. All analyses were operated by Treeage 2019.

RESULTS : Although low-dose rivaroxaban plus aspirin had more costs ($238,944), they simultaneously produced more QALYs (16.47). Likewise, aspirin alone had fewer costs ($218,104) and QALYs (15.93). The ICER of low-dose rivaroxaban plus aspirin versus aspirin alone was $ 38.591 per QALYs gained. PSA showed that the probability of cost-effectiveness for low-dose rivaroxaban plus aspirin and aspirin alone was 1.2% and 98.8% at $20,000, but 76.9% and 23.1% at $ 60,000.

CONCLUSIONS : This study revealed that low-dose rivaroxaban plus aspirin is likely to be a cost-effective alternative to aspirin with more QALY gained in the patients with stable CVDs from the national payer’s perspective in Taiwan. The pharmacoeconomic attraction of low-dose rivaroxaban plus aspirin might be influenced by the threshold of WTP. The result could provide a scientific reference for the policymakers in the making of treatment guideline or medical payment in Taiwan.