Cost-effectiveness of rivaroxaban plus aspirin versus aspirin alone in patients with stable coronary artery disease or peripheral artery disease: a systematic review.

Purpose: This study aimed to systematically review the cost-effectiveness of rivaroxaban plus aspirin (RIV + ASA) versus aspirin (ASA) alone in patients with stable coronary artery disease (CAD) or peripheral artery disease (PAD).

Methods: A systematic review was conducted using leading databases including PubMed, Scopus, and Web of Science core collection. The search was carried out up to June 25, 2024, focusing on identifying full economic evaluation studies comparing the cost-effectiveness of RIV + ASA versus ASA alone in patients with stable cardiovascular diseases (CVDs). The methodological quality of the included studies was assessed utilizing the validated Quality of Health Economics Studies (QHES) checklist. Subsequently, a qualitative analysis was performed to synthesize the collected data. We converted the incremental cost-effectiveness ratios (ICERs) into the equivalent amount in US dollars for the year 2024.

Results: Out of 315 identified articles, 11 met inclusion criteria and were included in the review. RIV + ASA was generally found to be cost-effective, with ICERs falling within acceptable willingness-to-pay (WTP) thresholds. However, substantial variation in ICERs was observed across studies due to differences in healthcare systems, drug pricing, and WTP thresholds. In these studies, ICERs per quality-adjusted life-year (QALY) were (in 2024 US dollars) US$4939 to $29,162 for all patients, $10,385 to $85,394 for CAD, and $1013 to $40,244 for PAD in different studies. RIV + ASA was more cost-effective in high-risk subgroups, such as patients with PAD. Key drivers of cost-effectiveness included mortality rates, the cost of rivaroxaban, and utility scores.

Conclusions: RIV + ASA appears to be a cost-effective treatment option for patients with CAD or PAD or both. Future research should address geographical biases, consider societal perspectives, and explore alternative treatment options to optimize resource allocation and improve patient outcomes in the management of CVDs. Future research should also consider evaluating the cost-effectiveness of alternative new oral anticoagulants (NOACs) to provide a broader perspective on treatment options for CVD.