OPEN Health, Rotterdam, The Netherlands.
Bayer AG, Berlin, Germany.
J Med Econ. 2021 Jan-Dec;24(1):1231-1239. doi: 10.1080/13696998.2021.1997024.
Patients with stable coronary artery disease (CAD) or peripheral artery disease (PAD) are at substantial risk of atherothrombotic events. The COMPASS trial showed that patients with stable CAD or PAD experienced significant benefits after treatment with rivaroxaban in combination with acetylsalicylic acid (ASA) compared with ASA alone. This paper aims to provide insight into the clinical and economic consequences of treatment with rivaroxaban from a Dutch societal perspective.
The clinical and economic implications of rivaroxaban in terms of the number of events prevented, costs, the incremental cost per life-years gained (LYG), and incremental cost per quality-adjusted life-years (QALYs) were determined based on a cost-effectiveness model for patients with stable CAD or PAD and in high-risk subgroups (i.e. patients with CAD and PAD, CAD and prior myocardial infarction and renal impairment, CAD and heart failure) using results from the Cardiovascular OutcoMes for People Using Anticoagulation Strategies (COMPASS) trial.
Patients treated with rivaroxaban have an expected increased discounted life expectancy of 0.67 years. In high-risk groups discounted incremental life expectancy ranged from 1.33 to 1.90 years. The incremental cost-effectiveness ratio for the full COMPASS population was €9,760/LYG and €12,033/QALY, whereas, for high-risk subgroups of patients with underlying conditions, incremental cost-effectiveness ratios ranged from €2,966/LYG to €5,052/LYG and from €3,940/QALY to €6,815/QALY. Results from the sensitivity analyses revealed that the model results were robust to variations in single or multiple input parameters at once.
The cost-effectiveness analysis showed that rivaroxaban in combination with ASA is a cost-effective treatment option in stable CAD or PAD patients. Rivaroxaban in combination with ASA is even more cost-effective in high-risk subgroups.
患有稳定型冠状动脉疾病（CAD）或外周动脉疾病（PAD）的患者发生动脉粥样血栓事件的风险很大。COMPASS 试验表明，与单独使用阿司匹林（ASA）相比，稳定型 CAD 或 PAD 患者接受利伐沙班联合 ASA 治疗后，获益显著。本文旨在从荷兰社会角度深入了解利伐沙班治疗的临床和经济后果。
基于稳定型 CAD 或 PAD 患者的心血管结局与抗凝策略使用（COMPASS）试验结果，通过成本效果模型，确定利伐沙班在预防事件数量、成本、每获得一个生命年的增量成本（LYG）和每获得一个质量调整生命年的增量成本（QALY）方面的临床和经济意义。
使用利伐沙班治疗的患者预期其预期的贴现寿命会增加 0.67 年。在高危亚组中，贴现增量寿命范围从 1.33 年到 1.90 年。全 COMPASS 人群的增量成本效果比为 9760 欧元/LYG 和 12033 欧元/QALY，而对于存在基础疾病的高危亚组患者，增量成本效果比范围从 2966 欧元/LYG 到 5052 欧元/LYG，从 3940 欧元/QALY 到 6815 欧元/QALY。敏感性分析结果表明，模型结果对单个或多个输入参数的变化具有稳健性。
成本效果分析表明，利伐沙班联合 ASA 是稳定型 CAD 或 PAD 患者的一种具有成本效果的治疗选择。利伐沙班联合 ASA 在高危亚组中更具成本效果。
