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J Med Econ. 2019 Apr;22(4):306-318. doi: 10.1080/13696998.2018.1563404. Epub 2019 Jan 15.

Rivaroxaban for non-valvular atrial fibrillation and venous thromboembolism in the Netherlands: a real-world data based cost-effectiveness analysis.

Author information

a Unit of PharmacoTherapy, -Epidemiology & -Economics , University of Groningen, Groningen Research Institute of Pharmacy (GRIP) , Groningen , the Netherlands.
b Department of Nephrology , University of Groningen, University Medical Center Groningen (UMCG) , the Netherlands.
c Asc Academics , Groningen , the Netherlands.
d Bayer , Mijdrecht , the Netherlands.
e Institute for Science in Healthy Aging & healthcaRE (SHARE) , University of Groningen, University Medical Center Groningen (UMCG) , Groningen , the Netherlands.
f Department of Health Sciences , University of Groningen, University Medical Center Groningen (UMCG) , the Netherlands.



Non-vitamin K antagonist oral anticoagulants (NOACs) have been included in international guidelines as important alternatives to vitamin K antagonists (VKAs) for the treatment of venous thromboembolism (VTE) and stroke prevention in non-valvular atrial fibrillation (NVAF). Meanwhile, in the Netherlands, NOACs are widely used next to VKAs. The objective of this study is to estimate the cost-effectiveness of treatment with rivaroxaban compared to VKAs in NVAF and VTE patients in the Netherlands, using data from international prospective observational phase IV studies.


Two models were developed to represent NVAF and VTE patients, populated with patients from the XANTUS (NCT01606995) and XALIA (NCT01619007) international prospective observational studies. The 1-year cost-effectiveness of rivaroxaban use, compared to VKAs, was explored in a population consisting of NVAF and VTE patients (base case) as well as for four scenarios with sub-populations: NVAF patients only, VTE patients only, NVAF patients with unstable international normalized ratio (INR), and NVAF patients using an INR self-measuring device.


In the base case, rivaroxaban saved €72,350 and gained 21 quality-adjusted life-years (QALYs) in a simulation of 2,000 patients over the use of VKAs. Ergo, rivaroxaban was dominant over VKAs. The probabilistic sensitivity analysis showed a probability of 85% for rivaroxaban being dominant and 100% at a willingness-to-pay threshold of €20,000/QALY. Rivaroxaban appeared to be dominant in all scenarios as well, except for the NVAF-patients-only scenario where the incremental cost-effectiveness ratio (ICER) was €157/QALY.


In patients with NVAF or VTE, rivaroxaban treatment is likely to be cost-effective and a potentially cost-saving alternative to VKA in the Netherlands.


I10; I19; Rivaroxaban; atrial fibrillation; cost-effectiveness; non-vitamin K oral anticoagulant; real world data; venous thromboembolism

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