scholarly journals Pharmacoeconomic study of rivaroxaban and acetylsalicylic acid combination use in patients with coronary artery disease and/or peripheral artery disease

2019 ◽  
pp. 76-86 ◽  
Author(s):  
N. V. Pogosova ◽  
A. V. Panov ◽  
A. Yu. Kulikov ◽  
V. G. Serpik ◽  
V. A. Kulikov
Keyword(s):  
Coronary Artery Disease ◽  
Cost Effectiveness ◽  
Coronary Artery ◽  
Acetylsalicylic Acid ◽  
Clinical Outcomes ◽  
Peripheral Artery Disease ◽  
Impact Analysis ◽  
Budget Impact ◽  
Peripheral Artery ◽  
Artery Disease

Aim. Comparative assessment of the economic results of rivaroxaban/acetylsalicylic acid (ASA) combination and ASA monotherapy use in patients with coronary artery disease (CAD) and/or peripheral artery disease (PAD). Material and methods. Based on the results of a large international multicenter, placebo-controlled, randomized clinical trial COMPASS, a model that evaluated the clinical outcomes of rivaroxaban/ASA combination and ASA monotherapy was formed. The economic results using cost and cost-effectiveness analyses, and budget impact analysis for two years were also calculated. The analysis took into account both direct medical costs (expenses for treatment, hospitalization due to complications, rehabilitation) financed under the compulsory health insurance, as well as indirect costs (loss of GDP due to disability or death). The calculation was made by accounting 100,000 patients with CAD and/or PAD.Results. Modeling of clinical outcomes per 100,000 patients based on COMPASS results showed a decrease of stroke prevalence by 649 cases, myocardial infarction — 301 cases, amputations — 478 cases, cardiovascular mortality — 476 cases when using rivaroxaban/ASA combination compared with ASA monotherapy. The cost-effectiveness analysis showed that rivaroxaban/ASA combination has greater clinical efficacy and lower costs in comparison with ASA monotherapy. Budget impact analysis showed that the switching of 100,000 patients with CAD and/or PAD from ASA monotherapy to rivaroxaban/ASA combination leads to budget savings of 1,026 million rubles in two years. This is due to a decrease in the incidence of cardiovascular events.Conclusion. It was found that the use of a rivaroxaban/ASA combination in comparison with ASA monotherapy in patients with CAD and/or PAD can both decrease a number of complications and lead to cost savings, despite the initially higher cost pharmacotherapy.

Rationale, design, and baseline participant characteristics in the MRI and cognitive substudy of the cardiovascular outcomes for people using anticoagulation strategies trial

2018 ◽  
Vol 14 (3) ◽  
pp. 270-281 ◽  
Author(s):  
Mukul Sharma ◽  
Robert G Hart ◽  
Eric E Smith ◽  
Jackie Bosch ◽  
Fei Yuan ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
White Matter ◽  
Cognitive Decline ◽  
Acetylsalicylic Acid ◽  
Peripheral Artery Disease ◽  
White Matter Hyperintensities ◽  
Peripheral Artery ◽  
Brain Infarcts ◽  
Artery Disease

Background Covert vascular disease of the brain manifests as infarcts, white matter hyperintensities, and microbleeds on MRI. Their cumulative effect is often a decline in cognition, motor impairment, and psychiatric disorders. Preventive therapies for covert brain ischemia have not been established but represent a huge unmet clinical need. Aims The MRI substudy examines the effects of the antithrombotic regimens in COMPASS on incident covert brain infarcts (the primary outcome), white matter hyperintensities, and cognitive and functional status in a sample of consenting COMPASS participants without contraindications to MRI. Methods COMPASS is a randomized superiority trial testing rivaroxaban 2.5 mg bid plus acetylsalicylic acid 100 mg and rivaroxaban 5 mg bid against acetylsalicylic acid 100 mg per day for the combined endpoint of MI, stroke, and cardiovascular death in individuals with stable coronary artery disease or peripheral artery disease. T1-weighted, T2-weighted, T2*-weighted, and FLAIR images were obtained close to randomization and near the termination of assigned antithrombotic therapy; biomarker and genetic samples at randomization and one month, and cognitive and functional assessment at randomization, after two years and at the end of study. Results Between March 2013 and May 2016, 1905 participants were recruited from 86 centers in 16 countries. Of these participants, 1760 underwent baseline MRI scans that were deemed technically adequate for interpretation. The mean age at entry of participants with interpretable MRI was 71 years and 23.5% were women. Coronary artery disease was present in 90.4% and 28.1% had peripheral artery disease. Brain infarcts were present in 34.8%, 29.3% had cerebral microbleeds, and 93.0% had white matter hyperintensities. The median Montreal Cognitive Assessment score was 26 (interquartile range 23–28). Conclusions The COMPASS MRI substudy will examine the effect of the antithrombotic interventions on MRI-determined covert brain infarcts and cognition. Demonstration of a therapeutic effect of the antithrombotic regimens on brain infarcts would have implications for prevention of cognitive decline and provide insight into the pathogenesis of vascular cognitive decline.

scholarly journals Health economic evaluation of rivaroxaban in the treatment of patients with chronic coronary artery disease or peripheral artery disease

2019 ◽  
Vol 116 (11) ◽  
pp. 1918-1924 ◽  
Author(s):  
Martin R Cowie ◽  
André Lamy ◽  
Pierre Levy ◽  
Stuart Mealing ◽  
Aurélie Millier ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Cost Effectiveness ◽  
Coronary Artery ◽  
Markov Model ◽  
Peripheral Artery Disease ◽  
Cost Effective ◽  
Peripheral Artery ◽  
Chronic Coronary Artery Disease ◽  
Life Years ◽  
Artery Disease

Abstract Aims In the COMPASS trial, rivaroxaban 2.5 mg twice daily (bid) plus acetylsalicylic acid (ASA) 100 mg once daily (od) performed better than ASA 100 mg od alone in reducing the rate of cardiovascular disease, stroke, or myocardial infarction (MI) in patients with coronary artery disease (CAD) and peripheral artery disease (PAD). A Markov model was developed to assess the cost-effectiveness of rivaroxaban plus ASA vs. ASA alone over a lifetime horizon, from the UK National Health System perspective. Methods and results The base case analysis assumed that patients entered the model in the event-free health state, with the possibility to experience ≤2 events, transitioning every three-month cycle, through acute and post-acute health states of MI, ischaemic stroke (IS), or intracranial haemorrhage (ICH), and death. Costs, quality-adjusted life-years (QALYs), life years—all discounted at 3.5%—and incremental cost-effectiveness ratios (ICERs) were calculated. Deterministic and probabilistic sensitivity analyses were conducted, as well as scenario analyses. In the model, patients on rivaroxaban plus ASA lived for an average of 14.0 years with no IS/MI/ICH, and gained 9.7 QALYs at a cost of £13 947, while those receiving ASA alone lived for an average of 12.7 years and gained 9.3 QALYs at a cost of £8126. The ICER was £16 360 per QALY. This treatment was cost-effective in 98% of 5000 iterations at a willingness-to-pay threshold of £30 000 per QALY. Conclusion This Markov model suggests that rivaroxaban 2.5 mg bid plus ASA is a cost-effective alternative to ASA alone in patients with chronic CAD or PAD.

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