Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2023 Jan 16;59(1):181.
doi: 10.3390/medicina59010181.

A Real-World Cost-Effectiveness Analysis of Rivaroxaban versus Vitamin K Antagonists for the Treatment of Symptomatic Venous Thromboembolism: Lessons from the REMOTEV Registry

Sabrina Kepka  1   2 , Elena-Mihaela Cordeanu  3   4 , Kevin Zarca  5 , Anne-Sophie Frantz  3 , Patrick Ohlmann  6 , Emmanuel Andres  7 , Pascal Bilbault  1   8 , Isabelle Durand-Zaleski  2   5   9 , Dominique Stephan  3   4
Affiliations
Observational Study

A Real-World Cost-Effectiveness Analysis of Rivaroxaban versus Vitamin K Antagonists for the Treatment of Symptomatic Venous Thromboembolism: Lessons from the REMOTEV Registry

Sabrina Kepka et al. Medicina (Kaunas). .

Abstract

Background and objectives: Venous thromboembolism (VTE) represents a health and economic burden with consequent healthcare resource utilization. Direct oral anticoagulants (DOACs) have emerged as the mainstay option for VTE treatment but few data exist on their cost-effectiveness as compared to the standard therapy (vitamin K antagonists (VKAs)). This study aimed to assess the cost-effectiveness of rivaroxaban compared to VKAs in VTE treatment by calculating the incremental cost effectiveness ratio (ICER). Materials and methods: We conducted a prospective observational study based on the REMOTEV registry, including patients hospitalized for VTE from 23 October 2013 to 31 July 2015, to evaluate the impact of the anticoagulant treatment (DOACs versus VKAs) on 6-month complications: major or clinically relevant non-major bleeding, VTE recurrence and all-cause death. Rivaroxaban was the only DOAC prescribed in this study. The ICER was calculated as the difference in costs divided by the difference in effectiveness. Results: Among the 373 patients included, 279 were treated with rivaroxaban (63.1 ± 17.9 years old; 49% men) and 94 with VKAs (71.3 ± 16.6 years old; 46% men). The mean cost was EUR 5662 [95% CI 6606; 9060] for rivaroxaban and EUR 7721 [95% CI 5130; 6304] for VKAs, while effectiveness was 0.0586 95% CI [0.0114; 0.126] for DOACs and 0.0638 [95% CI 0.0208; 0.109] for VKAs. The rivaroxaban treatment strategy was dominant with costs per patient EUR 2059 lower [95% CI -3582; -817] and a higher effectiveness of 0.00527 [95% CI -0.0606; 0.0761] compared to VKAs. Conclusions: This study provides real-world evidence that rivaroxaban is not only an efficient and safe alternative to VKAs for eligible VTE patients, but also cost-saving.

Keywords: cost-effectiveness; direct oral anticoagulant; pulmonary embolism; rivaroxaban; venous thromboembolism; vitamin K antagonist.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Study flowchart showing eligible patients’ selection. CRNM: clinically relevant non-major; DOACs: direct oral anticoagulants; VKAs: vitamin K antagonists; VTE: venous thromboembolism.
Figure 2
Figure 2
Standardized mean difference (SMD) before (red) and after (blue) inverse probability weighting from propensity scores. AH: arterial hypertension; CrCl: Cockcroft clearance of creatinine; sPESI: simplified Pulmonary Embolism Severity Index.
Figure 3
Figure 3
Scatter plot of incremental cost and effectiveness of rivaroxaban (red dots) compared to VKAs as the reference (blue dots). N: number.
See this image and copyright information in PMC

References

    1. Wendelboe A.M., Raskob G.E. Global burden of thrombosis: Epidemiologic aspects. Circ. Res. 2016;118:1340–1347. doi: 10.1161/CIRCRESAHA.115.306841. - DOI - PubMed
    1. Konstantinides S.V., Meyer G., Becattini C., Bueno H., Geersing G.J., Harjola V.-P., Huisman M.V., Humbert M., Jennings C.S., Jiménez D., et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European respiratory society (ERS) Eur. Heart J. 2020;41:543–603. doi: 10.1093/eurheartj/ehz405. - DOI - PubMed
    1. Sun D., Li L., Zhang X., Blanchard T.G., Fowler D.R., Li L. Causes of sudden unexpected death in schizophrenia patients: A forensic autopsy population study. Am. J. Forensic Med. Pathol. 2019;40:312–317. doi: 10.1097/PAF.0000000000000512. - DOI - PubMed
    1. Wichmann D., Sperhake J.P., Lütgehetmann M., Steurer S., Edler C., Heinemann A., Heinrich F., Mushumba H., Kniep I., Schröder A.S., et al. Autopsy findings and venous thromboembolism in patients with COVID-19: A prospective cohort study. Ann. Intern. Med. 2020;173:268–277. doi: 10.7326/M20-2003. - DOI - PMC - PubMed
    1. Raskob G.E., Angchaisuksiri P., Blanco A.N., Buller H., Gallus A., Hunt B.J., Hylek E.M., Kakkar A., Konstantinides S.V., McCumber M., et al. Thrombosis: A major contributor to global disease burden. Arterioscler. Thromb. Vasc. Biol. 2014;34:2363–2371. doi: 10.1161/ATVBAHA.114.304488. - DOI - PubMed

Publication types

LinkOut - more resources