OBJECTIVES: Comparison of cost-effectiveness of rivaroxaban with dabigatran in prevention of venous thromboembolism (VTE) in patients after total hip replacement (THR) from payer perspective in Slovakia. METHODS: In a cost-utility model results of two large randomized controlled trials were used. Patients in both studies received 35 days prophylaxis regimen: in RECORD 1 with rivaroxaban or enoxaparin and in RE-NOVATE with dabigatran or enoxaparin. Indirect comparison in metaanalysis showed that rivaroxaban reduced total VTE by 64% and symptomatic VTE by 82% versus dabigatran. Three parts of model represents prophylaxis, post-prophylaxis, and long-term complications. Data from RECORD 1 and RE-NOVATE trials are used for first part of the model. Published epidemiological and clinical data estimating the risk of further VTE events and post-thrombotic syndrome beyond the trial period were used in second and third part of the model. Published price lists (2010) were used for local cost data. Utilities related to VTE were derived from literature. Time horizon was set at 5 years and payers perspective was used. Quality-adjusted life years (QALY) were chosen for effectiveness measurement and discount rate of 5% per year for costs and effects was applied according to valid guidelines for health economic evaluation in Slovakia. One-way and probabilistic sensitivity analyses were performed. RESULTS: Rivaroxaban showed cost-effectiveness versus dabigatran, with a small cost reduction of 0.46 € and a QALY gain of 0.0016 per patient. In probabilistic analysis 84.3 % of simulations were below 18 000 €/QALY, which is officially published threshhold for willingness to pay in Slovakia. CONCLUSIONS: Rivaroxaban is a cost-effective alternative to dabigatran for the prevention of VTE following THR in Slovakian setting.