OBJECTIVES: In light of the Cardiovascular Outcomes for People using Anticoagulation Strategies (COMPASS) trial, our objective was to assess the cost-effectiveness, from the Australian healthcare perspective, of rivaroxaban in combination with aspirin versus aspirin alone for the prevention of recurrent cardiovascular disease among patients with stable atherosclerotic vascular disease.

METHODS: A Markov model was developed using input data from the COMPASS trial, and used to predict the clinical course and costs of patients over a 20-year time-horizon. The model comprised of three health states: ‘Alive without recurrent CVD’, ‘Alive after recurrent CVD’ and ‘Dead’. Costs were from the perspective of the Australian public healthcare system, and estimated from published sources, as were utility data. The costs of rivaroxaban were based on current acquisition prices on the Australian Pharmaceutical Benefits Schedule (PBS) and assumed to be AUD $3.09 per day. The main outcome of interest was the incremental cost-effectiveness ratio (ICER) in terms of cost per quality adjusted life year (QALY) gained, cost per year of life saved (YoLS) and the number needed to treat (NNT). Costs and benefits were discounted by 5.0% per year.

RESULTS: The NNT to prevent one additional acute CVD event for rivaroxaban plus aspirin versus aspirin alone was 39.2 over 20 years. The equivalent NNTs for cardiovascular death and overall death were 395.0 and 14.3, respectively. The number needed to harm (NNH) for major bleeding was 2.4. Compared to aspirin alone, rivaroxaban plus aspirin was estimated to cost an additional AUD $12,156 (discounted) per person, but lead to 0.516 YoLS (discounted) and 0.386 QALYs gained (discounted), over 20 years. These equated to an ICERs of AUD $23,560/YoLS and AUD$31,436/QALY gained.

CONCLUSIONS: Compared to aspirin, rivaroxaban in combination with aspirin is likely to be cost-effective in preventing recurrent cardiovascular events in patients with stable atherosclerotic vascular disease.