(B-183) Systematic Review: Cost-Benefit Analysis of Rivaroxaban Versus Warfarin Using a Decision Tree Model

Background: Effective anticoagulation is necessary to prevent complications and recurrence of venous thromboembolism (VTE). Although warfarin and rivaroxaban are both used, their clinical benefits and cost effectiveness vary.

Objectives: This systematic review aims at comparing the cost effectiveness analysis of warfarin with rivaroxaban in the treatment of VTE.

Methods: Studies published between 2010 and 2023 that compared rivaroxaban and warfarin for treating venous thromboembolism (VTE) were assessed. Database used were PubMed, Embase, and Google Scholar. 270 publications were found of which 16 met the inclusion criteria after being assessed for validity, quality and cost effectiveness. The study focused on the health system perspective. Time horizons of one year and lifetime were used. Decision tree models and Incremental Cost Effectiveness Ratios (ICERs) were also considered in the study. Information was gathered on clinical outcomes, medication expenses, monitoring costs, and quality-adjusted life years (QALYs). The study's quality was assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. The studies used originated from the US, UK, Canada, Germany and the Netherlands.

Results: Rivaroxaban was found to be cost-effective than warfarin with Rivaroxaban ICERs significantly below generally accepted limits (50,000 per QALY), ranging from €8,000 to 20,000 per QALY gained.
An ICER of €8,000 per QALY for rivaroxaban in the treatment of acute VTE was reported in a 2014 study published in Thrombosis and Haemostasis.
In a 2015 US study published in the Journal of Medical Economics, rivaroxaban is more cost effective than warfarin, with reduced overall healthcare expenses over a five-year period.
Rivaroxaban's ICER for preventing VTE after orthopaedic surgery was £7,000 per QALY, in a 2016 UK study published in BMJ Open.
The high cost of rivaroxaban was compensated by improved patient compliance, lower rates of severe bleeding, and less need for monitoring. Despite the differences in patient populations and healthcare systems, sensitivity analysis affirmed the findings' robustness.

Conclusions: Rivaroxaban is more cost effective as compared to warfarin for the treatment of VTE because it has more clinical benefits and reduced long-term healthcare costs. However, recommendations about treatment should be specific to each patient, taking into account local healthcare factors and patient-specific considerations. This review offers insightful information considering the goal of improving anticoagulant treatment in patients with VTE.