Article Text

Original research
Cost-effectiveness analysis and budget impact of rivaroxaban compared with dalteparin in patients with cancer at risk of recurrent venous thromboembolism
  1. Lisa A de Jong1,
  2. Annette W G van der Velden2,
  3. Marinus van Hulst3,4,
  4. Maarten J Postma4,5
  1. 1Unit of Pharmacotherapy, Epidemiology and Economics, University of Groningen, Groningen, The Netherlands
  2. 2Department of Internal Medicine, Martini Hospital, Groningen, The Netherlands
  3. 3Department of Clinical Pharmacy and Toxicology, Martini Hospital, Groningen, The Netherlands
  4. 4Department of Health Sciences, University Medical Centre Groningen, Groningen, The Netherlands
  5. 5Department of Economics, Econometrics & Finance, University of Groningen, Groningen, The Netherlands
  1. Correspondence to Dr Lisa A de Jong; l.a.de.jong{at}rug.nl

Abstract

Objectives In the ‘Comparison of an Oral Factor Xa Inhibitor With Low Molecular Weight Heparin in Patients With Cancer With Venous Thromboembolism’ (SELECT-D) trial, rivaroxaban showed relatively low venous thromboembolism (VTE) recurrence but higher bleeding compared with dalteparin in patients with cancer. We aim to calculate the cost-effectiveness and budget impact of rivaroxaban compared with dalteparin in patients with cancer at risk of recurrent VTE.

Setting We built a Markov model to calculate the cost-effectiveness from a societal perspective over a 5-year time horizon for the Dutch healthcare setting.

Participants A hypothetical cohort of 1000 cancer patients with VTE entered the model with baseline characteristics based on the SELECT-D trial.

Intervention Six months of treatment with rivaroxaban (15 mg two times per day for first 3 weeks followed by 20 mg once daily) was compared with 6 months of treatment with dalteparin (200 IU/kg daily during month 1 followed by 150 IU/kg daily).

Primary and secondary outcome measures The primary outcome of the cost-effectiveness analysis was the incremental cost-effectiveness ratio (ICER). The robustness of the model was evaluated in probabilistic and univariate sensitivity analyses. A budget impact analysis was performed to calculate the total annual financial consequences for a societal perspective in the Netherlands.

Results In the base case and all scenarios, rivaroxaban were cost-saving while also slightly improving the patient’s health, resulting in economically dominant ICERs. In the probabilistic sensitivity analysis, 77.8% and 98.7% of the simulations showed rivaroxaban to be cost-saving and more effective for a 5-year and 6-month time horizon, respectively. Rivaroxaban can save up to €11 326 763 (CI €5 164 254 to €17 363 231) in approximately 8000 cancer patients with VTE per year compared with dalteparin based on a 1-year time horizon.

Conclusions Treatment with rivaroxaban is economically dominant over dalteparin in patients with cancer at risk for recurrent VTE in the Netherlands. The use of rivaroxaban instead of dalteparin can save over €10 million per year, primarily driven by the difference in drug costs.

  • anticoagulation
  • oncology
  • thromboembolism
  • health economics
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Footnotes

  • Contributors LAdJ built the economic model, performed the analyses and contributed to the design of the work, interpretation of the results, writing of the manuscript. AWGvdV contributed to the interpretation of the results, writing of the manuscript and critical revision for important intellectual content. MvH contributed to the design of the work, interpretation of the results, writing of the manuscript and critical revision for important intellectual content. MJP contributed to the design of the work, interpretation of the results, writing of the manuscript and critical revision for important intellectual content. All authors approved of the version to be published.

  • Funding This work was supported by Bayer Pharma Netherlands. The sponsor was involved with the start of the project, but they were not involved in the identification of data, design, conduct and reporting of the analysis. Award/grant number: not applicable.

  • Competing interests LAdJ, MvH and AWGvdV declare that they have no competing interest with relation to subject. MJP has received research grants from various pharmaceutical companies, including but not limiting to Bayer, Pfizer, Bristol-Myers Squibb, GSK, Roche and Novartis.

  • Patient consent for publication Not applicable.

  • Ethics approval The analyses were conducted based on publicly available information which is presented and referenced in the article and Supporting Information files, and did therefore not require any patient consent forms or approval from an ethical review board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All relevant data are included in the manuscript. The analyses were conducted based on publicly available information which is presented and referenced in the manuscript.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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