OBJECTIVES: The purpose of this study was to perform comparative pharmacoeconomic analysis of antithrombotic therapy with rivaroxaban (Xarelto®) and enoxaparin (Clexane®) in the conditions of real clinical practice of total hip (THR) and knee (TKR) replacement.  METHODS: The method of budget impact modeling was used. RESULTS: At equal duration of venous thromboembolism (VTE) prophylaxis at THR (35 days)  rivaroxaban turned out to be more budget saving than enoxaparin by 2399 RUB (62.71€), reducing the quantity of complications cases (pulmonary embolism, deep venous thrombosis, death) by 26 cases per one thousand patients. At various duration of prophylaxis at THR - rivaroxaban (35 days) and enoxaparin (14 days) - rivaroxaban application has also demonstrated budget savings by 100 RUB(2.63€) thus reducing the quantity of complications by 74 cases per one thousand patients. The results of comparison of two weeks VTE prophylaxis after TKR have shown the most sizeable economy after  rivaroxaban application by 7734 RUB(202.164€ ) and simultaneous complications decrease by 92 cases per one thousand patients. CONCLUSIONS: Rivaroxaban demonstrated budget savings compared to enoxaparin at all prophylaxis regiments at THR and TKR  by reducing thrombosis complications.