COST-EFFECTIVENESS OF RIVAROXABAN WITHIN SUBGROUPS FOR ATRIAL FIBRILLATION AND VENOUS THROMBOEMBOLISM IN THE NETHERLANDS
Author(s)
Gout-Zwart J1, Sediq A1, van den Bosch M2, Postma MJ1
1University of Groningen, Groningen, The Netherlands, 2Bayer BV, Mijdrecht, The Netherlands
OBJECTIVES: The discovery of novel oral anticoagulants, such as rivaroxaban, has brought new treatment options for prevention of stroke in non-valvular atrial fibrillation (NVAF) patients and treatment of (recurrent) venous thromboembolism ((r)VTE). We explored if the benefits of rivaroxaban treatment could outweigh costs, compared to current standard therapy with vitamin K antagonists (VKAs) within specific subgroups in the Netherlands. METHODS: For NVAF and VTE a decision-tree was created, respectively based on the ROCKET AF and EINSTEIN pooled-analysis studies. The study was performed for a time-horizon of one year and from a healthcare payers’ perspective. For NVAF a VKA alone was used as comparator. For VTE the combination enoxaparin with acenocoumarol (23% of patients) or phenprocoumon (77% of patients) was used as comparative treatment. Both comparative treatments are guided by Dutch thrombotic services. Efficacy and safety of different drug therapies were taken into account, together with resulting costs and (dis)utilities. Results were specified for subgroups in scenario analyses: NVAF + VTE patients (base case); NVAF and VTE patients separately; unstable NVAF patients with TTR (time in therapeutic range) <60%A probabilistic sensitivity analysis (PSA) was performed to investigate the influence of parameter uncertainty on the incremental cost-effectiveness ratio (ICER). RESULTS: For the analyzed subgroups the use of rivaroxaban was cost saving and provided health gains compared to treatment with VKAs. Cost savings were highest for VTE patients, followed by unstable NVAF patients. Health gains were approximately the same for each subgroup at 0.023-0.026 quality adjusted life-years (QALY) per patient. CONCLUSIONS: From a healthcare payers perspective in the Dutch setting, rivaroxaban treatment is likely to be dominant over current standard therapy with VKAs, for the prevention of stroke in patients with (unstable) NVAF and treatment of (r)VTE.
Conference/Value in Health Info
2016-10, ISPOR Europe 2016, Vienna, Austria
Value in Health, Vol. 19, No. 7 (November 2016)
Code
PCV90
Topic
Economic Evaluation
Topic Subcategory
Cost-comparison, Effectiveness, Utility, Benefit Analysis
Disease
Cardiovascular Disorders