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

IF 2.8 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

American Journal of Cardiovascular Drugs Pub Date : 2023-12-28 DOI:10.1007/s40256-023-00620-6

Andre Lamy, John Eikelboom, Wesley Tong, Fei Yuan, Shrikant I. Bangdiwala, Jackie Bosch, Stuart Connolly, Eva Lonn, Gilles R. Dagenais, Kelley R. H. Branch, Wei-Jhih Wang, Deepak L. Bhatt, Jeffrey Probstfield, Georg Ertl, Stefan Störk, P. Gabriel Steg, Victor Aboyans, Isabelle Durand-Zaleski, Lars Ryden, Salim Yusuf

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引用次数: 0

Abstract

Background

Rivaroxaban 2.5 mg twice daily with aspirin 100 mg daily was shown to be better than aspirin 100 mg daily for preventing cardiovascular (CV) death, stroke or myocardial infarction in patients with either stable coronary artery disease (CAD) or peripheral artery disease (PAD). The cost-effectiveness of this regimen in this population is essential for decision-makers to know.

Methods

US direct healthcare system costs (in USD) were applied to hospitalized events, procedures and study drugs utilized by all patients. We determined the mean cost per participant for the full duration of the trial (mean follow-up of 23 months) plus quality-adjusted life years (QALYs) and the incremental cost-effectiveness ratio (ICER) over a lifetime using a two-state Markov model with 1-year cycle length. Sensitivity analyses were performed on the price of rivaroxaban and the annual discontinuation rate.

Results

The costs of events and procedures were reduced for Cardiovascular Outcomes for People Using Anticoagulation Strategies (COMPASS) patients who received rivaroxaban 2.5 mg orally (BID) plus acetylsalicylic acid (ASA) compared with ASA alone. Total costs were higher for the combination group ($7426 versus $4173) after considering acquisition costs of the study drug. Over a lifetime, patients receiving rivaroxaban plus ASA incurred $27,255 more and gained 1.17 QALYs compared with those receiving ASA alone resulting in an ICER of $23,295/QALY. ICERs for PAD only and polyvascular disease subgroups were lower.

Conclusion

Rivaroxaban 2.5 mg BID plus ASA compared with ASA alone was cost-effective (high value) in the USA.

COMPASS ClinicalTrials.gov identifier: NCT01776424.

Abstract Image

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COMPASS 试验中利伐沙班加阿司匹林与单用阿司匹林的成本效益比较：美国视角。

研究背景在预防冠状动脉疾病（CAD）或外周动脉疾病（PAD）稳定期患者的心血管（CV）死亡、中风或心肌梗死方面，利伐沙班（Rivaroxaban）2.5 毫克、每日两次、阿司匹林 100 毫克的效果优于阿司匹林 100 毫克。决策者必须了解这一治疗方案在这一人群中的成本效益：对所有患者的住院事件、治疗过程和研究药物采用美国直接医疗系统成本（以美元计）。我们采用周期为 1 年的双态马尔可夫模型，确定了每位参与者在整个试验期间（平均随访 23 个月）的平均成本、质量调整生命年 (QALY) 以及终生的增量成本效益比 (ICER)。对利伐沙班的价格和年停药率进行了敏感性分析：与单用乙酰水杨酸（ASA）相比，口服利伐沙班 2.5 毫克（BID）加乙酰水杨酸（ASA）的 "使用抗凝策略者的心血管结局"（COMPASS）患者的事件和手术费用有所降低。考虑到研究药物的购买成本，联合用药组的总成本更高（7426 美元对 4173 美元）。与单用 ASA 的患者相比，接受利伐沙班加 ASA 的患者在一生中多花费 27,255 美元，获得 1.17 QALY，ICER 为 23,295 美元/QALY。仅 PAD 和多血管疾病亚组的 ICER 更低：在美国，利伐沙班 2.5 mg BID 加 ASA 与单用 ASA 相比具有成本效益（高价值）。COMPASS ClinicalTrials.gov identifier：NCT01776424。

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来源期刊

American Journal of Cardiovascular Drugs 医学-心血管系统

CiteScore

6.70

自引率

3.30%

发文量

审稿时长

>12 weeks

期刊介绍： Promoting rational therapy within the discipline of cardiology, the American Journal of Cardiovascular Drugs covers all aspects of the treatment of cardiovascular disorders, particularly the place in therapy of newer and established agents. Via a program of reviews and original clinical research articles, the journal addresses major issues relating to treatment of these disorders, including the pharmacology, efficacy and adverse effects of the major classes of drugs; information on newly developed drugs and drug classes; the therapeutic implications of latest research into the aetiology of cardiovascular disorders; and the practical management of specific clinical situations. The American Journal of Cardiovascular Drugs offers a range of additional enhanced features designed to increase the visibility, readership and educational value of the journal’s content. Each article is accompanied by a Key Points summary, giving a time-efficient overview of the content to a wide readership. Articles may be accompanied by plain language summaries to assist patients, caregivers and others in understanding important medical advances. The journal also provides the option to include various other types of enhanced features including slide sets, videos and animations. All enhanced features are peer reviewed to the same high standard as the article itself. Peer review is conducted using Editorial Manager®, supported by a database of international experts. This database is shared with other Adis journals.