Rivaroxaban plus aspirin for the prevention of ischaemic events in patients with cardiovascular disease: a cost-effectiveness study

Svenja Petersohn*, Xavier Pouwels, Bram Ramaekers, Arina ten Cate-Hoek, Manuela Joore

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

58 Downloads (Pure)



Dual pathway inhibition with 2.5 mg rivaroxaban twice daily plus 100 mg aspirin once daily may be a promising alternative to 100 mg aspirin antiplatelet therapy for the prevention of cardiovascular events in patients with coronary artery disease and/or peripheral arterial disease. However, treatment costs and bleeding risks are higher, and there is another treatment option for peripheral arterial disease, 75 mg clopidogrel. A comprehensive assessment of benefits, risks and costs of dual pathway inhibition versus standard of care is needed.


We used a state transition model including cardiovascular, ischaemic limb and bleeding events to compare dual pathway inhibition to aspirin antiplatelet therapy in coronary artery disease, and additionally to clopidogrel antiplatelet therapy in peripheral arterial disease patients. We calculated the incremental cost-effectiveness ratio from costs and quality-adjusted life-years of lifelong treatment, and the cost-effectiveness probability at a euro50,000/quality-adjusted life-year threshold.


Quality-adjusted life-years and costs of dual pathway inhibition were highest, the incremental cost-effectiveness ratios versus aspirin were euro32,109 in coronary artery disease and euro26,381 in peripheral arterial disease patients, with 92% and 56% cost-effectiveness probability, respectively (clopidogrel was extendedly dominated). Incremental cost-effectiveness ratios were below euro20,000 in comorbid peripheral arterial disease patients and coronary artery disease patients younger than 65 years, incremental cost-effectiveness ratios were above euro50,000 in carotid artery disease patients and coronary artery disease patients older than 75 years.


Lifelong preventive treatment of coronary artery disease and peripheral arterial disease patients at risk of cardiovascular events with dual pathway inhibition improves health outcomes and seems overall cost-effective relative to aspirin antiplatelet therapy and also to clopidogrel antiplatelet therapy for peripheral arterial disease, particularly in comorbid patients, but not in older patients and in carotid artery disease patients. These findings may warrant a targeted approach.

Original languageEnglish
Pages (from-to)1354-1365
Number of pages12
JournalEuropean Journal of Preventive Cardiology
Issue number13
Publication statusPublished - Sept 2020


  • Peripheral arterial disease
  • coronary artery disease
  • rivaroxaban
  • aspirin
  • clopidogrel
  • cost-benefit analysis
  • EQ-5D
  • RISK


Dive into the research topics of 'Rivaroxaban plus aspirin for the prevention of ischaemic events in patients with cardiovascular disease: a cost-effectiveness study'. Together they form a unique fingerprint.

Cite this