Cost–effectiveness of rivaroxaban versus heparins for prevention of venous thromboembolism after total hip or knee surgery in Sweden

Abstract

Aims: The objective of this study was to evaluate the cost–effectiveness of rivaroxaban versus the low-molecular-weight heparins (LMWH) enoxaparin and dalteparin for the prevention of venous thromboembolism (VTE) after total hip replacement and total knee replacement in Sweden. Methods: The model included acute venous thromboembolic events and long-term complications over a 5-year time horizon represented by an acute and a chronic phase with 1-year cycles. Transition probabilities were derived from the Regulation of Coagulation in Orthopaedic Surgery to Prevent Deep Vein Thrombosis and Pulmonary Embolism (RECORD) clinical trials. Results: In patients undergoing total hip replacement, the incremental cost per additional quality-adjusted life-year of extended prophylaxis for 35 days with rivaroxaban versus 14 days of prophylaxis with enoxaparin or dalteparin was SEK29,400 and SEK35,400, respectively. In total knee replacement patients, 14 days of rivaroxaban dominated 14 days of LMWH as prophylaxis for VTE. Conclusion: The results of the economic model consistently showed that, over a 5-year period, rivaroxaban is a cost-effective alternative to 14 days of LMWH for VTE prophylaxis in Sweden.

Keywords::

• anticoagulants
• cost–effectiveness
• cost-utility
• dalteparin
• enoxaparin
• low-molecular-weight heparin
• rivaroxaban
• thromboprophylaxis
• thrombosis

Acknowledgements

The authors would like to acknowledge Chris Thomas, who provided editorial support.

Financial & competing interests disclosure

Lars Ryttberg has received honoraria from Bayer Pharma AG. Alex Diamantopoulos provided consulting services and is an employee of a private consultancy that provides services to the manufacturer of rivaroxaban. Fiona Forster provided consulting services to Bayer Pharma AG. Michael Lees was an employee of Bayer Plc. Anina Fraschke is an employee of Bayer AB. Ingela Björholt provided consulting services to Bayer Pharma AG. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Editorial support was provided by Chris Thomas. Funding for this was provided by Bayer HealthCare and Johnson & Johnson Pharmaceutical Research & Development, L.L.C.