Cost effectiveness of Rivaroxaban versus low molecular weight heparin and vitamin K antagonists for the treatment of deep-vein thrombosis in the Belgian healthcare setting

Objectives: The aim of the present study was to evaluate the cost-effectiveness of rivaroxaban versus current standard of care for the acute treatment of deep-vein thrombosis (DVT) and prevention of recurrent DVT and pulmonary embolism (PE) in the Belgian healthcare setting. Background: The mainstay of therapy for venous thromboembolism has been low-molecular-weight heparin (LMWH) for the initial treatment followed by oral vitamin K antagonists (VKAs) for the continued treatment during 3 to 12 months. VKAs are both effective and inexpensive, but require monitoring and carry a risk of bleeding. Rivaroxaban is the first novel oral anticoagulant that received approval for treating VTE, but there are few data on the cost-effectiveness of rivaroxaban versus LMWH/VKA. Methods: A Markov model was designed and populated with: 1) local cost estimates, 2) comparative 2 year clinical data from the EINSTEIN-DVT phase III trial comparing rivaroxaban with LMWH / VKA and 3) data from medical literature. The results are extrapolated to a total time horizon of 40 years. Results: Rivaroxaban was the dominant treatment option for patients requiring three months or six months treatment and cost-effective (€1,905 per QALY) for patients requiring twelve months of therapy. Sensitivity analyses showed these results were robust across a wide range of data input values. Conclusions: The results of the present cost-effectiveness analysis indicate that rivaroxaban provides a dominant or at least a cost-effective treatment alternative to LMWH/VKA for the treatment of DVT and prevention of recurrent DVT and PE in Belgium.