Department of Medicine, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
Department of Epidemiology and Technology Assessment, University of Maastricht, Maastricht, the Netherlands.
Chest. 2018 Dec;154(6):1371-1378. doi: 10.1016/j.chest.2018.08.1059. Epub 2018 Sep 7.
Using data from the Reduced-Dose 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.
Total health-care costs (2016 USD) 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 DVT, 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.
Rivaroxaban users had lower per patient per month (PPPM) clinical event costs compared with aspirin users ($123, $243, and $381 for rivaroxaban 10 mg, rivaroxaban 20 mg, and aspirin, respectively). However, vs aspirin, PPPM total health-care costs were $24 higher for patients treated with rivaroxaban 10 mg ($143 higher for rivaroxaban 20 mg) due to higher cost of rivaroxaban. With a 15% discount for rivaroxaban 10 mg, 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 health-care cost.
Continued therapy with rivaroxaban 10 and 20 mg vs aspirin was associated with lower clinical event costs but higher total health-care costs; with a 15% drug discount rivaroxaban 10 mg had lower total health-care costs than aspirin.
本研究使用 EINSTEIN-CHOICE 试验（瑞维鲁胺用于降低复发性症状性静脉血栓栓塞症的长期预防风险）中的数据，评估了利伐沙班与阿司匹林继续抗凝治疗的成本影响。
从美国管理式医疗的角度计算了利伐沙班和阿司匹林相关的总医疗保健成本（2016 年美元）。临床事件成本是通过乘以护理成本的事件发生率计算得出的。从 EINSTEIN-CHOICE 中获得了复发性肺栓塞、复发性 DVT、全因死亡率和出血的一年 Kaplan-Meier 临床事件发生率。护理成本通过文献回顾确定。药物成本是药物价格（批发采购成本）与治疗持续时间的乘积。进行了一次单因素敏感性分析。
与阿司匹林使用者相比，利伐沙班使用者的每位患者每月（PPPM）临床事件成本较低（利伐沙班 10mg、利伐沙班 20mg 和阿司匹林分别为 123 美元、243 美元和 381 美元）。然而，与阿司匹林相比，接受利伐沙班 10mg 治疗的患者的总医疗保健成本每月高出 24 美元（利伐沙班 20mg 则高出 143 美元），这是由于利伐沙班的成本较高。利伐沙班 10mg 给予 15%的折扣后，利伐沙班治疗患者的临床事件成本降低足以完全抵消较高的药物成本，使总医疗保健成本降低 19 美元。
与阿司匹林相比，继续接受利伐沙班 10mg 和 20mg 治疗与较低的临床事件成本相关，但总医疗保健成本较高；利伐沙班 10mg 给予 15%的药物折扣后，其总医疗保健成本低于阿司匹林。
