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The cost-effectiveness of rivaroxaban with or without aspirin in the COMPASS trial
Andre Lamy1,2,3,4, John Eikelboom1,5, Wesley Tong1,2
1Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada.
Insights
The combination of rivaroxaban and aspirin is highly cost-effective for preventing cardiovascular events in patients with stable coronary artery disease or peripheral artery disease. This strategy reduces healthcare costs and improves quality-adjusted life years in Canada, France, and Germany.
Area of Science:
- Cardiovascular Medicine
- Health Economics
Background:
- The COMPASS trial showed rivaroxaban plus aspirin is superior to aspirin alone for preventing major adverse cardiovascular events in stable coronary artery disease (CAD) or peripheral artery disease (PAD).
- Evaluating the cost-effectiveness of this strategy is crucial for clinical and policy decisions.
Purpose of the Study:
- To assess the cost-effectiveness of rivaroxaban 2.5 mg twice daily (BID) plus aspirin 100 mg compared to aspirin 100 mg alone in patients from the COMPASS trial.
Main Methods:
- An in-trial analysis was combined with a 33-year extrapolation using a two-state Markov model.
- Country-specific healthcare costs were applied to patient-level data, calculating quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs).
Main Results:
- The rivaroxaban plus aspirin group incurred higher total costs but gained 1.17 QALYs over a lifetime horizon.
- ICERs were $3946/QALY in Canada, $9962/QALY in France, and $10,264/QALY in Germany.
- Subgroup analyses revealed lower ICERs for patients with PAD and polyvascular disease.
Conclusions:
- Rivaroxaban 2.5 mg BID plus aspirin reduces direct healthcare costs and is highly cost-effective in Canada, France, and Germany, even after considering drug acquisition costs.
- This combination therapy represents a valuable strategy for managing cardiovascular risk in appropriate patient populations.
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).
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