Rivaroxaban scores points for lower costs, hospital stays

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Rivaroxaban, which has been approved by the FDA to treat deep vein thrombosis (DVT) or pulmonary embolism (PE) and to reduce the risk of recurrent DVT and PE following initial treatment, also appears to be resource friendly, according to two abstracts presented at the 2012 American Society of Hematology’s (ASH) annual meeting in Atlanta.

Craig D. Seaman, MD, of the University of Pittsburgh Medical Center in Pennsylvania, and colleagues explored the cost effectiveness of rivaroxaban (Xarelto, Janssen Pharmaceuticals) compared with warfarin for the prevention of recurrent venous thromboembolism (VTE). The FDA expanded the use of the anticoagulant’s indication in November under the agency’s priority review process. The FDA concluded that the safety and efficacy of rivaroxaban for the new indications had been evaluated in three clinical studies.

Seaman and colleagues developed a Markov model to assess cost effectiveness of the direct factor Xa inhibitor over a 10-year time period, using a hypothetical cohort of 60-year-old patients diagnosed with a first VTE who received six-month treatment of either rivaroxaban or warfarin. They determined cost estimates with Healthcare and Utilization Project data and probabilities of adverse events using EINSTEIN PE data. Costs were in 2011 U.S. dollars.

They calculated that total medication and medical costs for rivaroxaban totaled $4,057 compared with $7,004 for warfarin. Quality-adjusted life years (QALYs) gained for rivaroxaban was of 9.3 compared with 9.16 for warfarin, and rivaroxaban fell within the acceptable $100,000 per QALY gained range when major bleeding was less than 4.5 percent.

“Prophylactic anticoagulation with rivaroxaban appears to be a cost effective, and perhaps cost saving, alternative to warfarin for the prevention of recurrent VTE,” Seaman and colleagues concluded. They presented the abstract on Dec. 9.

In a separate study, Bonno van Bellen, MD, of Hospital Beneficencia Portuguesa in Sao Paulo, Brazil, and colleagues evaluated length of stay (LOS) with a single-drug regimen of rivaroxaban versus standard of care. They noted that in the latter treatment (parenteral low molecular weight heparin and fondaparinux plus a vitamin K antagonist), patients must achieve adequate anticoagulation levels before being discharged, while rivaroxaban did not require dose adjustments or monitoring.

For their analysis, van Bellen and colleagues used EINSTEIN DVT and EINSTEIN PE data. To calculate LOS, they culled investigator records for data on patient admissions and discharges. They found that in EINSTEIN DVT, the LOS was five days in the rivaroxaban group compared with eight days in the enoxaparin and vitamin K antagonist group. In EINSTEIN PE, the LOS was six days vs. seven days.

“These results indicated that a single-dose anticoagulation regimen using rivaroxaban significantly reduces the length of hospital stay for patients admitted for DVT and/or PE, relative to standard of care,” they wrote. “This has potential to reduce the treatment burden for patients and healthcare systems.”

They presented the abstract Dec. 10.