Health-care Cost Impact of Continued Anticoagulation With Rivaroxaban vs Aspirin for Prevention of Recurrent Symptomatic VTE in the EINSTEIN-CHOICE Trial Population

Philip S. Wells, Martin Prins, Jan Beyer-Westendorf, Anthonie W. A. Lensing, Lloyd Haskell, Bennett Levitan, Francois Laliberté , Veronica Ashton, Yongling Xiao, Dominique Lejeune, Concetta Crivera, P. Lefebvre, Qi Zhao, Zhong Yuan, Jeff Schein, Paolo Prandoni

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

BACKGROUND: Using data from the Reduced-Dose Rivaroxaban in the Long-Term Prevention of Recurrent Symptomatic Venous Thromboembolism (EINSTEIN-CHOICE) trial, this study assessed cost impact of continued anticoagulation therapy with rivaroxaban vs aspirin.

METHODS: Total health-care costs (2016 USD) associated with rivaroxaban and aspirin were calculated as the sum of clinical event costs and drug costs from a US managed care perspective. Clinical event costs were calculated by multiplying event rate by cost of care. One-year Kaplan-Meier clinical event rates for recurrent pulmonary embolism, recurrent DVT, all-cause mortality, and bleeding were obtained from EINSTEIN-CHOICE. Cost of care was determined by literature review. Drug costs were the product of drug price (wholesale acquisition cost) and treatment duration. A one-way sensitivity analysis was conducted.

RESULTS: Rivaroxaban users had lower per patient per month (PPPM) clinical event costs compared with aspirin users ($123, $243, and $381 for rivaroxaban 10 mg, rivaroxaban 20 mg, and aspirin, respectively). However, vs aspirin, PPPM total health-care costs were $24 higher for patients treated with rivaroxaban 10 mg ($143 higher for rivaroxaban 20 mg) due to higher cost of rivaroxaban. With a 15% discount for rivaroxaban 10 mg, the lower cost of clinical events for the rivaroxaban-treated patients more than fully offset the higher drug costs, and yielded a $19 lower total health-care cost.

CONCLUSIONS: Continued therapy with rivaroxaban 10 and 20 mg vs aspirin was associated with lower clinical event costs but higher total health-care costs; with a 15% drug discount rivaroxaban 10 mg had lower total health-care costs than aspirin.

Original languageEnglish
Pages (from-to)1371-1378
Number of pages8
JournalChest
Volume154
Issue number6
DOIs
Publication statusPublished - Dec 2018

Keywords

  • anticoagulants
  • aspirin
  • cost comparison
  • economic analysis
  • extended treatment
  • rivaroxaban
  • recurrent VTE
  • DEEP-VEIN THROMBOSIS
  • VENOUS THROMBOEMBOLISM
  • ORAL ANTICOAGULANTS
  • EXTENDED TREATMENT
  • ECONOMIC BURDEN
  • ALL-CAUSE
  • WARFARIN
  • MODEL

Cite this

Wells, P. S., Prins, M., Beyer-Westendorf, J., Lensing, A. W. A., Haskell, L., Levitan, B., Laliberté , F., Ashton, V., Xiao, Y., Lejeune, D., Crivera, C., Lefebvre, P., Zhao, Q., Yuan, Z., Schein, J., & Prandoni, P. (2018). Health-care Cost Impact of Continued Anticoagulation With Rivaroxaban vs Aspirin for Prevention of Recurrent Symptomatic VTE in the EINSTEIN-CHOICE Trial Population. Chest, 154(6), 1371-1378. https://doi.org/10.1016/j.chest.2018.08.1059