|
1
|
Arabloo J, Rezaei MA, Makhtoumi V, Sadiani ZM, Rezapour A. Cost-effectiveness of rivaroxaban plus aspirin versus aspirin alone in patients with stable coronary artery disease or peripheral artery disease: a systematic review. Eur J Clin Pharmacol 2025; 81:279-290. [PMID: 39714728 DOI: 10.1007/s00228-024-03794-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2024] [Accepted: 12/18/2024] [Indexed: 12/24/2024]
Abstract
PURPOSE This study aimed to systematically review the cost-effectiveness of rivaroxaban plus aspirin (RIV + ASA) versus aspirin (ASA) alone in patients with stable coronary artery disease (CAD) or peripheral artery disease (PAD). METHODS A systematic review was conducted using leading databases including PubMed, Scopus, and Web of Science core collection. The search was carried out up to June 25, 2024, focusing on identifying full economic evaluation studies comparing the cost-effectiveness of RIV + ASA versus ASA alone in patients with stable cardiovascular diseases (CVDs). The methodological quality of the included studies was assessed utilizing the validated Quality of Health Economics Studies (QHES) checklist. Subsequently, a qualitative analysis was performed to synthesize the collected data. We converted the incremental cost-effectiveness ratios (ICERs) into the equivalent amount in US dollars for the year 2024. RESULTS Out of 315 identified articles, 11 met inclusion criteria and were included in the review. RIV + ASA was generally found to be cost-effective, with ICERs falling within acceptable willingness-to-pay (WTP) thresholds. However, substantial variation in ICERs was observed across studies due to differences in healthcare systems, drug pricing, and WTP thresholds. In these studies, ICERs per quality-adjusted life-year (QALY) were (in 2024 US dollars) US$4939 to $29,162 for all patients, $10,385 to $85,394 for CAD, and $1013 to $40,244 for PAD in different studies. RIV + ASA was more cost-effective in high-risk subgroups, such as patients with PAD. Key drivers of cost-effectiveness included mortality rates, the cost of rivaroxaban, and utility scores. CONCLUSIONS RIV + ASA appears to be a cost-effective treatment option for patients with CAD or PAD or both. Future research should address geographical biases, consider societal perspectives, and explore alternative treatment options to optimize resource allocation and improve patient outcomes in the management of CVDs. Future research should also consider evaluating the cost-effectiveness of alternative new oral anticoagulants (NOACs) to provide a broader perspective on treatment options for CVD.
Collapse
Affiliation(s)
- Jalal Arabloo
- Health Management and Economics Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Rezaei
- Hospital Management Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran.
| | - Vahid Makhtoumi
- School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Zahra Mollaei Sadiani
- School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Aziz Rezapour
- Health Management and Economics Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
|
2
|
Lamy A, Eikelboom J, Tong W, Yuan F, Bangdiwala SI, Bosch J, Connolly S, Lonn E, Dagenais GR, Branch KRH, Wang WJ, Bhatt DL, Probstfield J, Ertl G, Störk S, Steg PG, Aboyans V, Durand-Zaleski I, Ryden L, Yusuf S. The Cost-Effectiveness of Rivaroxaban Plus Aspirin Compared with Aspirin Alone in the COMPASS Trial: A US Perspective. Am J Cardiovasc Drugs 2024; 24:117-127. [PMID: 38153624 PMCID: PMC10806169 DOI: 10.1007/s40256-023-00620-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/20/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND Rivaroxaban 2.5 mg twice daily with aspirin 100 mg daily was shown to be better than aspirin 100 mg daily for preventing cardiovascular (CV) death, stroke or myocardial infarction in patients with either stable coronary artery disease (CAD) or peripheral artery disease (PAD). The cost-effectiveness of this regimen in this population is essential for decision-makers to know. METHODS US direct healthcare system costs (in USD) were applied to hospitalized events, procedures and study drugs utilized by all patients. We determined the mean cost per participant for the full duration of the trial (mean follow-up of 23 months) plus quality-adjusted life years (QALYs) and the incremental cost-effectiveness ratio (ICER) over a lifetime using a two-state Markov model with 1-year cycle length. Sensitivity analyses were performed on the price of rivaroxaban and the annual discontinuation rate. RESULTS The costs of events and procedures were reduced for Cardiovascular Outcomes for People Using Anticoagulation Strategies (COMPASS) patients who received rivaroxaban 2.5 mg orally (BID) plus acetylsalicylic acid (ASA) compared with ASA alone. Total costs were higher for the combination group ($7426 versus $4173) after considering acquisition costs of the study drug. Over a lifetime, patients receiving rivaroxaban plus ASA incurred $27,255 more and gained 1.17 QALYs compared with those receiving ASA alone resulting in an ICER of $23,295/QALY. ICERs for PAD only and polyvascular disease subgroups were lower. CONCLUSION Rivaroxaban 2.5 mg BID plus ASA compared with ASA alone was cost-effective (high value) in the USA. COMPASS ClinicalTrials.gov identifier: NCT01776424.
Collapse
Affiliation(s)
- Andre Lamy
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada.
- CADENCE Research Group, Hamilton Health Sciences, Hamilton, ON, Canada.
- Department of Surgery, McMaster University, Hamilton, ON, Canada.
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
- DBCVSRI C1-112, 237 Barton St, Hamilton, Canada, L8L2X2.
| | - John Eikelboom
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Wesley Tong
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
- CADENCE Research Group, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Fei Yuan
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
| | | | - Jackie Bosch
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Stuart Connolly
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Eva Lonn
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Gilles R Dagenais
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec, QC, Canada
| | | | - Wei-Jhih Wang
- Comparative Health Outcomes, Policy and Economics Institute, School of Pharmacy, University of Washington, Seattle, WA, USA
| | - Deepak L Bhatt
- Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Georg Ertl
- University of Würzburg, Würzburg, Germany
- Department of Clinical Research & Epidemiology, Comprehensive Heart Failure Center, and Department of Internal Medicine I, University Hospital, Würzburg, Germany
| | - Stefan Störk
- Department of Clinical Research & Epidemiology, Comprehensive Heart Failure Center, and Department of Internal Medicine I, University Hospital, Würzburg, Germany
| | - P Gabriel Steg
- INSERMU-1148 and FACT (French Alliance for Cardiovascular Trials), Université Paris-Cité, Paris, France
- Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Paris, France
- Institut Universitaire de France, Paris, France
| | - Victor Aboyans
- Inserm U1094 & IRD 270, Limoges University, and Department of Cardiology, Dupuytren University Hospital, Limoges, France
| | - Isabelle Durand-Zaleski
- Assistance Publique Hôpitaux de Paris, URC Eco and Santé Publique, Hôpital Henri Mondor, Créteil, France
- Université Paris est Créteil, Créteil, France
- INSERM CRESS UMR 1153, Paris, France
| | - Lars Ryden
- Department of Medicine K2, Karolinska Institutet, Stockholm, Sweden
| | - Salim Yusuf
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| |
Collapse
|
|
3
|
Lamy A, Eikelboom J, Tong W, Yuan F, Bangdiwala SI, Bosch J, Connolly S, Lonn E, Dagenais GR, Branch KRH, Wang WJ, Bhatt DL, Probstfield J, Ertl G, Störk S, Steg PG, Aboyans V, Durand-Zaleski I, Ryden L, Yusuf S. The cost-effectiveness of rivaroxaban with or without aspirin in the COMPASS trial. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2023; 9:502-510. [PMID: 36001989 DOI: 10.1093/ehjqcco/qcac054] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 08/09/2022] [Accepted: 08/18/2022] [Indexed: 05/23/2023]
Abstract
AIMS The Cardiovascular Outcomes for People Using Anticoagulation Strategies (COMPASS) trial demonstrated that rivaroxaban 2.5 mg BID with aspirin 100 mg was more effective than aspirin 100 mg daily alone for the prevention of cardiovascular (CV) death, stroke, or myocardial infarction in patients with stable coronary artery disease (CAD) or peripheral artery disease (PAD). We aimed to examine the cost-effectiveness of rivaroxaban using patient-level data from the COMPASS trial. METHODS AND RESULTS We performed an in-trial analysis and extrapolated our results for 33 years using a two-state Markov model with a 1-year cycle length. Hospitalization events, procedures, and study drugs were documented for patients. We applied country-specific (Canada, France, and Germany) direct healthcare system costs (in USD) to healthcare resources consumed by patients. Average cost per patient during the trial (mean follow-up of 23 months), quality-adjusted life years (QALYs), and lifetime cost-effectiveness were calculated. Costs of events and procedures were reduced with rivaroxaban 2.5 mg BID with aspirin. The addition of rivaroxaban 2.5 mg BID increased total costs for the combination group. Over a lifetime horizon (in trial +33 years), rivaroxaban plus aspirin was associated with 1.17 QALYs gained, yielding an incremental cost-effectiveness ratio (ICER) of $3946/QALY, $9962/QALY, and $10 264/QALY in Canada, France, and Germany, respectively. PAD and polyvascular disease subgroups had lower ICERs. CONCLUSION Rivaroxaban 2.5 mg twice daily plus aspirin compared with aspirin alone reduces direct healthcare costs. After acquisition costs of rivaroxaban, the lifetime cost-effectiveness of 2.5 mg twice daily plus aspirin is highly cost-effective in Canada, France, and Germany.(COMPASS ClinicalTrials.gov identifier: NCT01776424).
Collapse
Affiliation(s)
- Andre Lamy
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
- CADENCE Research Group, Hamilton Health Sciences, Hamilton, Ontario, Canada
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - John Eikelboom
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Wesley Tong
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
- CADENCE Research Group, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Fei Yuan
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Shrikant I Bangdiwala
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Jackie Bosch
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Stuart Connolly
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Eva Lonn
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Gilles R Dagenais
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Québec, Canada
| | | | - Wei-Jhih Wang
- Comparative Health Outcomes, Policy and Economics Institute, School of Pharmacy, University of Washington, USA
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA, USA
| | - Jeff Probstfield
- Division of Cardiology, University of Washinton, Seattle, WA, USA
| | - Georg Ertl
- Department of Medicine I, University of Würzburg, WürzburgGermany
- Comprehensive Heart Failure Center, University Hospital, Würzburg, Germany
| | - Stefan Störk
- Department of Medicine I, University of Würzburg, WürzburgGermany
- Comprehensive Heart Failure Center, University Hospital, Würzburg, Germany
| | - P Gabriel Steg
- Department of Cardiology, Université Paris Diderot, Paris, France
- Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Victor Aboyans
- Department of Cardiology, Dupuytren University Hospital, and Inserm 1094 & IRD, NET, Limoges University, Limoges, France
| | - Isabelle Durand-Zaleski
- Assistance Publique Hôpitaux de Paris, URC Eco and Santé Publique, Hôpital Henri Mondor, Créteil, France
- Health Economics Research Unit, Université Paris Est Créteil, Créteil, France
- INSERM ECEVE UMR 1123, ParisFrance
| | - Lars Ryden
- Cardiology Unit, Department of Medicine K2, Karolinska Institutet, Stockholm, Sweden
| | - Salim Yusuf
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|