The Cost-Effectiveness of Rivaroxaban Plus Aspirin Compared with Aspirin Alone in the COMPASS Trial: A US Perspective

Area of Science:

• Cardiovascular Medicine
• Health Economics
• Pharmacoeconomics

Background:

• Rivaroxaban 2.5 mg twice daily plus aspirin 100 mg daily demonstrated superior efficacy over aspirin alone in preventing major adverse cardiovascular events in patients with stable coronary artery disease (CAD) or peripheral artery disease (PAD).
• Assessing the cost-effectiveness of this combination regimen is crucial for healthcare decision-makers.

Purpose of the Study:

• To evaluate the cost-effectiveness of rivaroxaban 2.5 mg BID plus aspirin 100 mg daily compared to aspirin alone for patients with stable CAD or PAD in the US healthcare system.

Main Methods:

• A lifetime cost-effectiveness analysis was conducted using a two-state Markov model with a 1-year cycle length.
• US direct healthcare system costs were applied to hospitalized events, procedures, and study drugs.
• Quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs) were calculated. Sensitivity analyses were performed on drug price and discontinuation rates.

Main Results:

• The rivaroxaban plus aspirin group incurred higher total costs ($7426 vs $4173) due to drug acquisition, but demonstrated reduced costs for events and procedures.
• Over a lifetime, the combination therapy resulted in an additional cost of $27,255 and gained 1.17 QALYs, yielding an ICER of $23,295/QALY.
• Lower ICERs were observed in the peripheral artery disease (PAD) only and polyvascular disease subgroups.

Conclusions:

• Rivaroxaban 2.5 mg BID plus aspirin is a cost-effective strategy in the USA for patients with stable CAD or PAD.
• This combination therapy represents high value for preventing cardiovascular outcomes in the studied population.