Cost-effectiveness and budget impact analysis of rivaroxaban in the treatment of deep vein thrombosis under private health care system perspective

Abstract

Introduction: Acute Venous thromboembolism (VTE) is a common pathology with an incidence of 1 to 2 cases per 1000 people. Currently, the standard of care consists of subcutaneous enoxaparin twice daily and warfarin for 6 months. Rivaroxaban presents an alternative to standard treatment for deep vein thrombosis (DVT). This article aims to assess the cost-effectiveness of rivaroxaban VS standard of care in patients with DVT. Methods: A Markov model was built in order to represent natural history of disease. Transition probabilities were derived from pivotal studies and systematic reviews. All cost data were taken from published sources and are represented in R$. The perspective was from private payers, therefore only direct costs relevant to healthcare maintenance organizations were included. Outcomes are expressed in the form of quality-adjusted life-years (QALYs). A life time horizon was considered and 5% discount rate applied as recommended in Brazilian health technology assessment guidelines. Probabilistic sensitivity analysis (PSA) was conducted in order to assess robustness of findings. Results: Treatment with rivaroxaban was dominant when compared to the standard of care, providing a potential cost saving of R$ 811 and an additional 0.006 QALYs per patient treated. These findings were supported by the PSA, which found that rivaroxaban had a 98% likelihood of dominating the standard of care. Conclusion: Findings suggest rivaroxaban as a dominant alternative for the treatment of VTE. Reductions in costs are associated with less follow-up exams when compared to actual standard of care.