Cost-effectiveness analysis of rivaroxaban plus aspirin versus aspirin alone in secondary prevention among patients with
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ORIGINAL ARTICLE
Cost-effectiveness analysis of rivaroxaban plus aspirin versus aspirin alone in secondary prevention among patients with chronic cardiovascular diseases Mei-Chuan Lee 1,2 & Chia-Te Liao 2,3 & Han Siong Toh 4,5 & Chih-Chen Chou 6,7 & Wei-Ting Chang 3,5,8 & Zhih-Cherng Chen 3,9 & Wen-Shiann Wu 3,9 & Tsung Yu 2 & Carol Strong 2 Accepted: 18 August 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose This study aimed to investigate the cost-effectiveness of low-dose rivaroxaban plus aspirin versus aspirin alone for patients with stable cardiovascular diseases in the Taiwan setting. Methods We constructed a Markov model to project the lifetime direct medical costs and quality-adjusted life-years of both therapies. Transitional probabilities were derived from the COMPASS trial, and the costs and utilities were obtained from the Taiwan National Health Insurance Database and published studies. One-way, scenario, subgroup, and probabilistic sensitivity analyses were performed to assess the uncertainty. Incremental cost-effectiveness ratio was presented as the outcome. The threshold of willingness-to-pay was set at US$76,368 (3 times the gross domestic product per capita of Taiwan). All analyses were operated by TreeAge 2019 and Microsoft Excel. Results The incremental cost-effectiveness ratios of rivaroxaban plus aspirin versus aspirin alone in the patients with stable cardiovascular diseases, coronary artery diseases, and peripheral artery diseases were US$83,459, US$69,852 and −US$13,823 per quality-adjusted life-year gained, respectively. The probabilistic sensitivity analyses showed that the probabilities of costeffectiveness for the regimen with rivaroxaban among those with cardiovascular diseases and coronary artery diseases were 44.1% and 65.3% at US$76,368. Conclusion Low-dose rivaroxaban plus aspirin is less likely to be a cost-effective alternative to aspirin in secondary prevention for the patients with stable cardiovascular diseases; however, among these patients, the regimen may have pharmacoeconomic incentives for the group merely having chronic coronary artery diseases from the Taiwan national payer’s perspective. The pharmacoeconomic incentives are influenced by the drug price, event treatment fees, and willingness-to-pay threshold. Keywords Cost-effectiveness . Rivaroxaban . Cardiovascular diseases . Coronary artery diseases . Secondary prevention Mei-Chuan Lee and Chia-Te Liao contributed equally to this work. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10557-020-07059-w) contains supplementary material, which is available to authorized users. * Chia-Te Liao [email protected] 1
Department of Pharmacy, Chi Mei Medical Center, Tainan, Taiwan
2
Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
3
Division of Cardiology, Department of Internal Medicine, Chi Mei Medical Center, No901, Rd. Zhonghua, Yong Kang District, Tainan City, Taiwan
4
Department o
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