OBJECTIVES: The aim of this study was to evaluate the cost-effectiveness of rivaroxaban and apixaban versus enoxaparin for the universal prophylaxis of venous thromboembolism (VTE) and associated long-term complications in Chinese patients after total hip replacement (THR). METHODS: A 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 of the 3 strategies for Chinese patients after THR. Transition propabilities in acute VTE were derived from two randomized controlled studies RECORD1 and ADVANCE3 of patients after THR. Transition probabilities in the long-term complications after acute VTE, utilities and costs were derived from published literature and local healthcare settings. One-way and probabilistic sensitivity analyses were performed to test the uncertainty concerning the model parameters. Quality-adjusted life year (QALY) and direct medical costs were reported over a five-year horizon. Incremental cost-effectiveness ratios (ICERs) were calculated. RESULTS: Thromboprophylaxis with apixaban was estimated to cause higher cost (US $106.69) with more health benefits (0.0026 QALY) in comparison with enoxaparin, resulting in an ICER of US $41,816 per QALY gained which was above 3×GDP per capital 2014 in China (US $22,140). Due to higher cost and lower QALYs generated, rivaroxaban was dominated by enoxaparin among post-THR patients. Sensitivity analyses confirmed the results. CONCLUSIONS: The analysis found that use of enoxaparin in Chinese patients after THR appears to be dominant compared with rivaroxaban, and cost-effective versus apixaban.