TY - JOUR
T1 - Rivaroxaban plus aspirin for the prevention of ischaemic events in patients with cardiovascular disease
T2 - a cost-effectiveness study
AU - Petersohn, Svenja
AU - Pouwels, Xavier
AU - Ramaekers, Bram
AU - ten Cate-Hoek, Arina
AU - Joore, Manuela
N1 - Funding Information:
The author(s) would like to thank Barend Mees and Hugo ten Cate for their support developing the PAD model structure and validating model input and results with their expert opinion; the contents of this publication are solely the responsibility of the authors.
Publisher Copyright:
© The European Society of Cardiology 2020.
PY - 2020/9
Y1 - 2020/9
N2 - BackgroundDual 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.MethodsWe 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.ResultsQuality-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.ConclusionLifelong 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.
AB - BackgroundDual 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.MethodsWe 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.ResultsQuality-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.ConclusionLifelong 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.
KW - Peripheral arterial disease
KW - coronary artery disease
KW - rivaroxaban
KW - aspirin
KW - clopidogrel
KW - cost-benefit analysis
KW - ARTERY-DISEASE
KW - DOUBLE-BLIND
KW - REVASCULARIZATION
KW - TICAGRELOR
KW - GUIDELINES
KW - EQ-5D
KW - RISK
U2 - 10.1177/2047487320913380
DO - 10.1177/2047487320913380
M3 - Article
C2 - 32223323
SN - 2047-4873
VL - 27
SP - 1354
EP - 1365
JO - European Journal of Preventive Cardiology
JF - European Journal of Preventive Cardiology
IS - 13
ER -