OBJECTIVES: The objective of the analysis was to assess the cost-effectiveness of rivaroxaban 2.5 mg twice daily(BID) in addition to standard care versus standard care alone for the secondary prevention of acute coronary syndromes(ACS) from a Greek social security system perspective.

METHODS: A two-parts Markov model has been used including an observational part, capturing the ATLAS ACS 2-TIMI 51 trial data, and an extrapolation part to model patients until they die. The target population were patients with ACS and elevated cardiac biomarkers without a prior history of stroke or transient ischemic attack (TIA). The model was designed to reflect the clinical trial data and the fact that ACS patients may suffer further myocardial infarctions (MI), ischemic (IS) or haemorrhagic strokes (HS), fatal MI, IS, HS, other CVD or other non-CVD events throughout their lifetime. Only direct health care costs have been included from a Greek social security system perspective. Future cost and effects were discounted at 3.5%. Univariate and probabilistic sensitivity analyses were conducted.

RESULTS: In the base case, the use of rivaroxaban 2.5 mg BID was associated with improvements in survival and quality-adjusted life years (QALYs), yielding an incremental cost per life year gained (LYG) of 3.508,93€ andan incremental cost per QALY of 4.150,53€. Univariate sensitivity analyses supported the robustness of the outcomes. Assuming a willingness-to-pay threshold of 20,000€/QALY, probabilistic sensitivity analysis demonstrated that the probability of rivaroxaban 2.5mg BID to be cost-effective is more than 99%. The results remain favourable for all subgroups included in the ATLAS ACS 2-TIMI 51 trial.

CONCLUSIONS: Rivaroxaban 2.5 mg BID in addition to standard care can be considered a cost-effective treatment option for the Greek patients with ACS and elevated cardiac biomarkers without a prior history of stroke or TIA.