Cost-effectiveness of rivaroxaban versus warfarin anticoagulation for the prevention of recurrent venous thromboembolism: A US perspective
Cost-effectiveness of rivaroxaban versus warfarin anticoagulation for the prevention of recurrent venous thromboembolism: A US perspective
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DOI：
10.1016/j.thromres.2013.09.015
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发表时间：
2013-12-01
影响因子：
7.5
通讯作者：
Ragni, Margaret V.
中科院分区：
文献类型：
--
作者：
Seaman, Craig D.;Smith, Kenneth J.;Ragni, Margaret V.
前言：利伐沙班是一种口服Xa直接因子抑制剂，在预防复发静脉血栓栓塞症(VTE)方面不逊于华法林。然而，利伐沙班在预防VTE复发方面是否具有成本效益尚不清楚。材料和方法：为了比较利伐沙班和华法林预防VTE复发的成本效果，我们建立了一个10年时间跨度的马尔可夫状态转换模型。基本病例分析包括一组假想的60岁的首次VTE患者，他们接受了利伐沙班或华法林3-12个月的二级预防。费用估计数来自医疗保健和利用项目和其他来源。概率是基于文学价值的。结果：与华法林相比，利伐沙班的成本更低(3195美元比6188美元)，效果更好(9.29 QALY比9.14 QALY)。我们的结果在敏感度分析中是非常稳健的。当利伐沙班的大出血风险超过3.8%(基础病例估计：0.96%)时，华法林不再由利伐沙班主导。结论：综上所述，利伐沙班预防性抗凝似乎是预防VTE复发的一种经济有效且可能节省成本的替代方案。(C)2013爱思唯尔有限公司。保留所有权利。
Introduction: Rivaroxaban is an oral direct factor Xa inhibitor that is noninferior to warfarin in the prevention of recurrent venous thromboembolism(VTE). Whether rivaroxaban is cost-effective in the prevention of recurrent VTE, however, is not known.Material and Methods: To assess the cost effectiveness of rivaroxaban compared with warfarin in the prevention of recurrent VTE, we built a Markov state-transition model over a 10-year time horizon. The base case analysis consisted of a hypothetical cohort of 60-year-old patients with an initial VTE who received secondary prophylaxis with either rivaroxaban or warfarin for 3 to 12 months. Cost estimates were derived from the Healthcare and Utilization Project and other sources. Probabilities were based on literature values. Outcomes included costs in 2011 United States dollars, quality-adjusted life-years (QALYs), and incremental cost effectiveness ratios (ICERs) over 10 years from a societal perspective.Results: Compared with warfarin, the rivaroxaban strategy cost less ($3,195 vs. $6,188) and was more effective (9.29 QALYs vs 9.14 QALYs). Our results were highly robust in sensitivity analyses. Warfarin was no longer dominated by rivaroxaban when the risk of major bleeding with rivaroxaban exceeds 3.8% (base case estimate: 0.96%).Conclusion: In summary, prophylactic anticoagulation with rivaroxaban appears to be a cost effective, and perhaps cost saving, alternative to warfarin for the prevention of recurrent VTE. (C) 2013 Elsevier Ltd. All rights reserved.