Economic analysis of the treatment of venous thromboembolism with rivaroxaban in comparison with enoxaparin plus warfarin under the perspective of the Brazilian Private Healthcare System

Abstract

Objective: Venous thromboembolism (VTE) is associated with a significant healthcare burden. Rivaroxaban is an oral anticoagulant, direct factor Xa inhibitor, that has the advantage of not requiring routine coagulation monitoring and dose adjustment according to laboratory parameters of coagulation. The objective of this study is to compare the direct costs of rivaroxaban with the combination of enoxaparin/warfarin and estimate the budget impact of the reimbursement by the Brazilian Private Healthcare System. Methods: A cost-minimization and a budget impact analysis were per formed comparing rivaroxaban versus enoxaparin/warfarin, in one-year time horizon and under the perspective of the Brazilian Private Healthcare System. Medical direct costs were considered for the hospitalization period (drugs, hospitalization, outpatient care and adverse events). Eligible patients were estimated through an epidemiological approach for the healthcare system and stratified by health management organization profile. Results: Estimated total cost of VTE treatment with rivaroxaban may cause a R$ 1.996,99 economy comparing to enoxaparin/warfarin, mainly due to fewer hospitalization days. The budget impact of the reimbursement of rivaroxaban in the Brazilian Private Healthcare System presented potential resource in all scenarios evaluated. Robustness of the model was tested by deterministic sensitivity analysis in which the resource saving promoted by rivaroxaban was maintained in all variations. Conclusion: Rivaroxaban is an alternative for the treatment of VTE that has potential to promote resource for the Brazilian Private Healthcare System.