OBJECTIVES: To evaluate the cost-effectiveness of rivaroxaban compared with dabigatran and enoxaparin for the prophylaxis of venous thromboembolism in patients undergoing elective total hip replacement (THR) in the context of Russian health care system. METHODS: A decision-tree model on the choice of regimens for thromboprophylaxis after THR was adopted from the model, developed by McCullagh et. al. (2009). Primary outcomes was mortality, occurrence of distal and proximal DVT, rates of symptomatic PE. Incidence of gastrointestinal bleeding, stroke and death was also included into the model. Delphi method was used to determine typical practice and cost of management of DVT and PE. It was assumed that patients with DVT were treated for 90 days, patients with PE – for 180 days. All patients in the model received thromboprophylaxis with one of the following regimens: rivaroxaban dose of 10 mg/day orally for 31-39 days (RECORD 2); dabigatran dose of 220 mg/day orally for 28-35 days (RE-NOVETE); enoxaparin dose of  40 mg/day subcutaneously for 10-14 days (RECORD 2). Incremental cost-effectiveness ratios (ICERs) were calculated. RESULTS: The cost of prophylaxis with enoxaparin was 6991 USD, with dabigatran  - 7076 USD, with rivaroxaban - 7147 USD. Although rivaroxaban has more effectiveness in preventing DVT (0.016 vs. 0.082 vs. 0.045) and PE (0.0012 vs. 0.005 vs. 0.004) than enoxaparin and dabigatran correspondingly. ICER to prevent 1 case of deep vein thrombosis after THR in rivaroxaban versus enoxaparin was 23.6 USD, and in dabigatran versus enoxaparin was 22.9 USD. ICER to prevent 1 case of pulmonary thromboembolism after THR in rivaroxaban versus enoxaparin was 556.7 USD, and in dabigatran versus enoxaparin was 850.3 USD. CONCLUSIONS: Despite of higher cost of prophylaxis of DVT and PE with rivaroxaban, comparing to enoxaparin and dabigatran, prophylaxis with rivaroxaban was more effective with acceptable ICERs.