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Cost-Effectiveness Analysis of Rivaroxaban for Treatment of Deep Vein Thrombosis and Pulmonary Embolism in Greece

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Abstract

Background and Objective

Venous thromboembolism (VTE), comprising deep-vein thrombosis (DVT) and pulmonary embolism (PE), is a major healthcare concern that results in substantial morbidity and mortality with great economic burden for healthcare systems. Hence, the need for effective and efficient treatment of patients with VTE is important for both clinical and economic reasons. The objective of this study was to evaluate the cost effectiveness of rivaroxaban compared to standard of care (SoC) with enoxaparin followed by dose-adjusted vitamin-K antagonists for the treatment of DVT and PE in Greece.

Methods

An existing Markov model was locally adapted from a third-party payer perspective to reflect the management and complications of DVT and PE in the course of 3-month cycles, up to death. The clinical inputs and utility values were extracted from published studies. Direct medical costs, obtained from local resources, were incorporated in the model and refer to year 2017. Both costs and outcomes were discounted at 3.5%. The incremental cost-effectiveness ratio (ICER) per quality-adjusted life year (QALY) gained was calculated. Probabilistic sensitivity analysis (PSA) was carried out to deal with uncertainty.

Results

The base-case analysis showed that rivaroxaban in 3- and 6-month treatment duration for DVT and PE, respectively, as this is the common clinical practice in Greece, was associated with a 0.02 and 0.01 increment in QALYs compared to SoC, respectively. Rivaroxaban was associated with a reduced total cost in DVT (€85) but with an additional total cost in PE (€2) compared to SoC. Therefore, rivaroxaban was a dominant (less costly, more effective) and cost-effective (ICER: €177) alternative over SoC for the management of DVT and PE, respectively. PSA revealed that the probability of rivaroxaban being cost effective at a threshold of €34,000 per QALY gained was 99% and 81% for DVT and PE, respectively.

Conclusion

Rivaroxaban may represent a cost-effective option relative to SoC for the management of DVT and PE in Greece.

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Acknowledgements

The authors would like to thank Bayer Hellas for sponsoring this study.

Author information

Authors and Affiliations

  1. Department of Health Services Organization and Management, National School of Public Health, 196 Alexandras Avenue, 11521, Athens, Greece

    George Gourzoulidis & Nikos Maniadakis

  2. The Stavros Niarchos Foundation-Collaborative Center for Clinical Epidemiology and Outcomes Research (CLEO), School of Medicine, National and Kapodistrian University of Athens, Athens, Greece

    Georgia Kourlaba

  3. Department of Vascular Surgery, Attikon Hospital, Athens University Medical School, Athens, Greece

    John Kakisis

  4. Department of Surgery – Vascular Surgery Unit, School of Medicine, University of Ioannina, Ioannina, Greece

    Mitiadis Matsagkas

  5. First Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloníki, Greece

    George Giannakoulas

  6. Department of Respiratory Medicine, University Hospital of Larissa, University of Thessaly, Larissa, Greece

    Konstantinos I. Gourgoulianis

  7. Department of Critical Care and Pulmonary Services, Evangelismos Hospital, University of Athens Medical School, Athens, Greece

    Theodoros Vassilakopoulos

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  1. George Gourzoulidis
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  2. Georgia Kourlaba
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  4. Mitiadis Matsagkas
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  5. George Giannakoulas
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  6. Konstantinos I. Gourgoulianis
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  7. Theodoros Vassilakopoulos
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  8. Nikos Maniadakis
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Corresponding author

Correspondence to George Gourzoulidis.

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Funding

This study was funded by Bayer Hellas. However, the study sponsor had no input into the study design, data collection, data analysis, or writing of the manuscript.

Conflict of interest

GGian received speaker honoraria from Bayer Hellas. NM received consulting fees from Bayer Hellas. MM received speaker honoraria from Bayer Hellas. TV received speaker honoraria from Bayer Hellas. None of the other authors has any personal or financial conflicts of interest.

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Gourzoulidis, G., Kourlaba, G., Kakisis, J. et al. Cost-Effectiveness Analysis of Rivaroxaban for Treatment of Deep Vein Thrombosis and Pulmonary Embolism in Greece. Clin Drug Investig 37, 833–844 (2017). https://doi.org/10.1007/s40261-017-0540-1

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