Healthcare Cost Impact of Continued Anticoagulation with Rivaroxaban versus Aspirin for Prevention of Recurrent Symptomatic Venous Thromboembolism in the EINSTEIN-CHOICE Trial Population

Background Using data from the Reduced-dosed Rivaroxaban in the Long-term Prevention of Recurrent Symptomatic Venous Thromboembolism (EINSTEIN-CHOICE) trial, this study assessed cost impact of continued anticoagulation therapy with rivaroxaban vs. aspirin. Methods Total healthcare costs (2016USD) associated with rivaroxaban and aspirin were calculated as the sum of clinical event costs and drug costs from a US managed care perspective. Clinical event costs were calculated by multiplying event rate by cost of care. One-year Kaplan-Meier clinical event rates for recurrent pulmonary embolism, recurrent deep-vein thrombosis, all-cause mortality, and bleeding were obtained from EINSTEIN-CHOICE. Cost of care was determined by literature review. Drug costs were the product of drug price (wholesale acquisition cost) and treatment duration. A one-way sensitivity analysis was conducted. Results Rivaroxaban users had lower per patient per month (PPPM) clinical event costs compared with aspirin users ($123, $ 243, and $381 for rivaroxaban 10mg, rivaroxaban 20mg, and aspirin, respectively). However, vs. aspirin, PPPM total healthcare costs were $24 higher for rivaroxaban 10mg treated patients ($143 higher for rivaroxaban 20mg) due to higher cost of rivaroxaban. With a 15% discount for rivaroxaban 10mg, the lower cost of clinical events for the rivaroxaban-treated patients more than fully offset the higher drug costs, and yielded a $19 lower total healthcare cost. Conclusions Continued therapy with rivaroxaban 10mg and 20mg vs. aspirin was associated with lower clinical event costs but higher total healthcare costs; with a 15% drug discount rivaroxaban 10mg had lower total healthcare costs than aspirin.