OBJECTIVES: To estimate the cost effectiveness of rivaroxaban against enoxaparin for the prophylaxis of venous thromboembolism (VTE) in patients after total hip replacement (THR) in Slovakia from payer perspective. METHODS: A cost-utility model based on results of large randomized controlled trial (RECORD 1) was developed.  In RECORD1, patients received 35 days prophylaxis with rivaroxaban or enoxaparin. Rivaroxaban reduced total VTE (composite: any DVT, non-fatal PE, all-cause mortality) by 70% versus enoxaparin after 35 days prophylaxis. The model was divided into three parts: prophylaxis, post-prophylaxis, and long-term complications. The first two parts represents acute phase and were modeled as a decision tree. Third part represents the long-term complications and was developed as a Markov model. The first part of the model is populated by RECORD 1 trial, while published epidemiological and clinical data estimating the risk of further VTE events and post-thrombotic syndrome beyond the trial period were used in second and third part of the model. Local cost data was based on published price lists, clinical guidelines, product labels and expert opinion. VTE related utilities were used from literature. Effectiveness was measured in quality-adjusted life years (QALY). Time horizon was set at 5 years and payers perspective was used. Discount rate was 7% per year for costs and effects according to Ministry of Health (MoH) guidelines for health economic evaluation valid in 2008. One-way and probabilistic sensitivity analyses were performed. RESULTS: Rivaroxaban was cost-effective versus enoxaparin, with an incremental cost per QALY of €9672.10. This is significantly below officially published €26,500 /QALY threshold for willingness to pay in Slovakia. Over 1,000 samples of probabilistic sensitivity analysis, 633 simulations were below a threshold of €26,500. CONCLUSIONS: Rivaroxaban is a cost-effective alternative to enoxaparin for the prevention of VTE following THR in Slovakian setting.