The economic implications of switching to rivaroxaban from enoxaparin plus vitamin K antagonist in the treatment of venous thromboembolism

Abstract

Objective:

Venous thromboembolism (VTE) impacts ∼900,000 individuals annually in the US, causing up to 100,000 deaths. Patients experiencing VTE have heightened risk of recurrence. Initial parenteral anti-coagulation is standard therapy for acute VTE followed by ≥3 months of warfarin, which introduces the risk of major bleeding. Balancing increased risks of bleeding and recurrent VTE remains challenging. Recent clinical trials suggest that rivaroxaban, an oral direct inhibitor of factor Xa, provides an effective, safe, simplified approach to treatment. This study considers the economic implications of these data.

Methods:

This study modeled inpatient, acute, and 1-year VTE costs for a hypothetical commercial plan with 1 million members. At baseline, all VTE patients receive standard therapy. Alternatively, 25% are instead treated with rivaroxaban. Model inputs are trial- and literature-based.

Results:

Standard therapy for VTE consumes 9474 inpatient days ($31.6 million). Added to that is treatment for 74 recurrences ($1.4 million); major and non-major bleed events ($1 million); and direct costs of anti-coagulation ($5.3 million). Alternatively, a 25% shift to oral anti-coagulation with rivaroxaban reduces inpatient days (by 5%); associated acute-care costs (by 2%); recurrences and costs (by 6%). Four major bleeding events are prevented, at the cost of one additional non-major bleeding event, which, taken together, reduce net utilization by 9%. Direct costs of anti-coagulation increase by 5%.

Conclusion:

The reduction in inpatient utilization, recurrences, and major bleeding resulting from a 25% shift from standard therapy to rivaroxaban following acute VTE would conserve ∼$860,475 for every 1 million commercial health plan enrollees.

Keywords::

• Venous thromboembolism
• Deep vein thrombosis
• Pulmonary embolism
• Rivaroxaban
• Standard therapy
• Burden of illness
• Cost analysis

Transparency

Declaration of funding

This research was supported by Janssen Scientific Affairs, LLC.

Declaration of financial/other relationships

KO received consulting fees from Janssen Scientific Affairs, LLC for the development of this paper. AP and BB are employees of Janssen Scientific Affairs, LLC, a subsidiary of Johnson & Johnson (J&J). SM was an employee of Janssen Scientific Affairs, LLC at the time of this research. Janssen Pharmaceuticals, Inc. markets rivaroxaban.

Acknowledgments

The authors gratefully acknowledge Dr Nancy Neil for her writing assistance and support with the development of this manuscript.