OBJECTIVES: Current standard treatment of pulmonary embolism (PE) in Canada involves a low molecular weight heparin (LMWH) and vitamin K antagonist (VKA).  However, such treatment has limitations. Rivaroxaban, an oral factor Xa inhibitor, was recently approved approved by Health Canada for the treatment of venous thromboembolic events (VTE - deep vein thrombosis [DVT], pulmonary embolism [PE]) and prevention of recurrent DVT and PE.  EINSTEIN-PE compared rivaroxaban to enoxaparin/VKA for 3, 6 or 12 months of treatment post-PE. Rivaroxaban was non-inferior to enoxaparin/VKA for recurrent VTE (HR: 1.12, 95%CI 0.75-1.68) and demonstrated a significant reduction in major bleeding (HR: 0.49, 95%CI 0.31-0.79, P=0.003). STUDY QUESTION: What is the incremental cost/QALY gained, from a Canadian provincial government perspective, for rivaroxaban compared to LMWH/VKA for treatment of PE, over a 5 year horizon? METHODS: A Markov model was developed.  Patients entered the model with an index PE and required 3, 6 or 12 months of treatment. Patients were exposed to treatment-specific risks of recurrent VTE and bleeding events, and associated mortality and long-term complications. Clinical inputs were from EINSTEIN-PE and published literature. Economic inputs were from publically available Canadian sources. Consistent with EINSTEIN-PE, a reduction in hospital length of stay was included for admitted patients treated with rivaroxaban. Utility inputs were from published literature. Extensive sensitivity analyses were conducted. RESULTS: Rivaroxaban dominated LMWH/VKA at all treatment durations examined.  In patients appropriate for 3, 6 and 12 months treatment, rivaroxaban demonstrated per patient cost savings of $629, $561 and $341 ($CAN), and QALY gains of 0.002, 0.004 and 0.005, respectively. Findings were robust to sensitivity analysis.  CONCLUSIONS: Rivaroxaban is a cost-effective treatment for PE, dominating LMWH/VKA for patients requiring up to 12 months treatment.  The positive clinical and economic profiles of rivaroxaban together make it a valuable treatment option for Canadian PE patients and payers.