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

de Jong, L. A., Gout-Zwart, J. J., van den Bosch, M., Koops, M. & Postma, M. J., 3-Apr-2019, In : Journal of Medical Economics. 22, 4, p. 306-318 13 p.

Research output: Contribution to journalArticleAcademicpeer-review

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 our 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 one-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 subpopulations: 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 potentially cost-saving alternative to VKA in the Netherlands.

Original languageEnglish
Pages (from-to)306-318
Number of pages13
JournalJournal of Medical Economics
Volume22
Issue number4
Early online date7-Jan-2019
Publication statusPublished - 3-Apr-2019

    Keywords

  • PULMONARY-EMBOLISM, STROKE PREVENTION, ORAL RIVAROXABAN, GUIDELINES, MANAGEMENT, WARFARIN, ESC

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