OBJECTIVES: Venous thromboembolism (VTE), comprising deep-vein thrombosis (DVT) and pulmonary embolism (PE), is a major healthcare concern that results in substantial morbidity and mortality with great economic burden for healthcare systems. Hence, the need for effective and efficient treatment of patients with VTE is important for both clinical and economic reasons. The objective of this study was to project the cost-effectiveness of apixaban compared with rivaroxaban in the treatment of acute VTE and prevention of recurrent VTE in China health care setting.

METHODS: A Markov decision model, which included both the acute VTE (represented as a decision tree) and the long-term complications (represented as a Markov model), was developed to assess economic outcomes in Chinese VTE patients receiving either apixaban or rivaroxaban. Transition probabilities and utilities were obtained from the literatures. Direct medical costs, obtained from local resources. Both costs and outcomes were discounted at 5%. The incremental cost-effectiveness ratio (ICER) per quality-adjusted life year (QALY) gained was calculated. Probabilistic sensitivity analysis (PSA) was carried out to deal with uncertainty.

RESULTS: The base-case analysis showed that apixaban saved ¥2,876.14 and 0.009 quality-adjusted life years (QALYs) and 0.010 LYs were gained compared with rivaroxaban. apixaban was associated with a reduced total cost in DVT (-¥21.46) and PE (-¥1.93) compared to rivaroxaban. Therefore, apixaban was a dominant (less costly, more effective) alternative over rivaroxaban for the management of DVT and PE. PSA revealed that the probability of apixaban being cost effective at a threshold of ¥53,980.00 per QALY gained was100%.

CONCLUSIONS: In acute anticoagulation use apixaban was found to be cost-saving in comparion with rivaroxaban. Lower drug costs of Apixaban indicated a more favorable ICER. The cost-effectiveness of long-term or life-long use should be tested in future research.