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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

1
a Unit of PharmacoTherapy, -Epidemiology & -Economics , University of Groningen, Groningen Research Institute of Pharmacy (GRIP) , Groningen , the Netherlands.
2
b Department of Nephrology , University of Groningen, University Medical Center Groningen (UMCG) , the Netherlands.
3
c Asc Academics , Groningen , the Netherlands.
4
d Bayer , Mijdrecht , the Netherlands.
5
e Institute for Science in Healthy Aging & healthcaRE (SHARE) , University of Groningen, University Medical Center Groningen (UMCG) , Groningen , the Netherlands.
6
f Department of Health Sciences , University of Groningen, University Medical Center Groningen (UMCG) , the Netherlands.

Abstract

BACKGROUND:

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.

METHODS:

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.

RESULTS:

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.

CONCLUSIONS:

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.

KEYWORDS:

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

PMID:
30614320
DOI:
10.1080/13696998.2018.1563404
[Indexed for MEDLINE]

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