Cost-effectiveness and budget impact analysis of rivaroxaban in the prevention of thromboembolic events in patient performing hip and knee arthroplasty in comparison to dabigatrana, enoxaparina and no prophylaxis under private health care system perspe

Abstract

Objectives: To develop a cost-effectiveness and a budget impact analysis (BIA) of rivaroxaban in the prevention of thromboembolic events (TE) in patients performing hip arthroplasty (HA) and knee arthroplasty (KA) in comparison with dabigatran, enoxaparin and no treatment under the Brazilian private health care system perspective. Methods: A decision tree analysis was developed for the first 90 days, considering the occurrence of deep venous thrombosis, pulmonary embolism and thromboembolic events, followed by a Markov model, for post thrombotic syndrome and thrombotic pulmonary hypertension. The time-horizon analyzed was 5 year. Epidemiological and efficacy data were obtained from scientific literature. The outcomes were expressed as number of all TE. The analysis considered only direct medical costs. Unit costs were obtained from Brazilian official database. The BIA considers that rivaroxaban will get 20% of the market in the first year with a growth of 15% per year in subsequent years. Results: Total costs considering the indication for KA and HA, respectively, were: rivaroxaban (BRL288-US$169 / BRL251-US$147); dabigatran (BRL303-US$178 / BRL406-US$239); enoxaparin (BRL565-US$332 / BRL389-US$229) and no treatment (BRL1,012- -US$596 / BRL394-US$232). Considering KA, the number of all TE with rivaroxaban was the same of dabigatran and lower than enoxaparin and no treatment. Considering HA, the number of all TE with rivaroxaban was the same of enoxaparin and lower than dabigatran and no treatment. The BIA estimated that the use of rivaroxaban leads to an economy to Brazilian health system. Conclusion: The treatment with rivaroxaban shown to reduce treatment costs and events compared with dabigatran, enoxaparin and no treatment.