OBJECTIVES:  Rivaroxaban is the only new oral anticoagulant with three indications approved in China to reduce the risk of stroke among people with non-valvular atrial fibrillation (NVAF), treat deep vein thrombosis (DVT), and prevent Venous thromboembolism (VTE) after total knee or hip replacement surgery (TKR &THR). The objective of this study was to evaluate the budget impact of introducing rivaroxaban in the management of AF, DVT, TKR and THR patients from payers’ perspective. METHODS:  An Excel-based budget impact model was developed. Model inputs included the prevalence of AF patients, the incidence of DVT, TKR and THR patients, the proportion of target patients receiving rivaroxaban, the efficacy and safety of treatment choices, cost data, and resultant health care utilization. Most of the variables were from literature, including the epidemiology data, efficacy, safety and costs. Two different scenarios were applied according to the setting of the threshold of willingness to pay, i.e.2-3 times GDP per capita in the top 100 cities in China. Costs and cost savings were reported as year-2016 CNY. RESULTS: The largest cost savings associated was observed in TKR and THR patients to prevent DVT and PE (CNY 163.7 million and CNY 221.4 million in two scenarios). In DVT populations, the cost savings were also observed with CNY 47.9 million and CNY 63.7 million in two scenarios. While for AF populations, the budget would increase due to the pharmacy costs with additional CNY 74.0 million to CNY 149.0 million. The main drivers for cost saving include the avoided event costs, administration costs in AF and DVT population and the overall costs in TKR and THR patients. CONCLUSIONS: The introduction of rivaroxaban as a treatment option for patients with AF, DVT, TKR, and THR could achieve substantial cost savings for payers. The total combined savings ranged from CNY 62.7 million to CNY 211.1 million.