PharmacoEconomics & Outcomes News 592 - 28 Nov 2009

Rivaroxaban the dominantthromboprophylactic

Results from a cost-effectiveness model conducted inIreland show that, from a health service executiveperspective, thromboprophylaxis with rivaroxaban[Xarelto] dominates both dabigatran etexilate [Pradaxa]and enoxaparin sodium in patients undergoing eithertotal knee replacement (TKR) or total hip replacement(THR) surgery.

In terms of direct medical costs, a 14-day rivaroxabanregimen dominated 10 days of dabigatran etexilate and10 days of enoxaparin sodium in patients undergoingTKR surgery. Dabigatran etexilate also dominatedenoxaparin sodium.

In THR patients, a 35-day rivaroxaban regimendominated a 35-day dabigatran etexilate regimen and 14days of enoxaparin sodium. The incremental cost-effectiveness ratio for dabigatran etexilate comparedwith enoxaparin sodium was €23 934 per life yeargained or €17 835 per quality-adjusted life year (QALY)gained (2008 values).

At a cost-effectiveness threshold of €45 000 perQALY, there was a 46% probability that rivaroxaban wasthe most cost-effective strategy in TKR patients and a39% probability that it was the most cost-effectivestrategy in THR patients. It was also 30% probable thatdabigatran etexilate was most cost effective in TKRpatients and 32% probable it was most cost effective inTHR patients.McCullagh L, et al. A cost-effectiveness model comparing rivaroxaban anddabigatran etexilate to enoxaparin sodium as thromboprophylaxis after total hipand total knee replacement in the Irish healthcare setting. PharmacoEconomics 27:829-846, No. 10, 2009 801131380

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PharmacoEconomics & Outcomes News 28 Nov 2009 No. 5921173-5503/10/0592-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved