Academic journal article Applied Health Economics and Health Policy

11th Annual European Congress of the International Society for Pharmacoeconomics and Outcomes Research (ISPOR): Athens, Greece, 8-11 November 2008

Academic journal article Applied Health Economics and Health Policy

11th Annual European Congress of the International Society for Pharmacoeconomics and Outcomes Research (ISPOR): Athens, Greece, 8-11 November 2008

Article excerpt

The 11th Annual European Congress of the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) was held recently in Athens, Greece, at the Hilton Athens and attracted around 1200 submissions, a 28% increase. The following is a selection of some of the research highlights from this meeting.

1 . Rivaroxaban for Venous Thromboembolism Prevention in Various Settings

The recently completed RECORD trials have shown that rivaroxaban has better efficacy and safety than enoxaparin when used prophylactically for venous thromboembolism (VTE) after major orthopaedic surgeries such as total hip replacement (THR) and total knee replacement (TKR). Using data from the RECORD trials, five studies presented at ISPOR suggest that rivaroxaban appears to be a cost-effective alternative to enoxaparin for the prevention of VTE after such surgeries. These studies were supported by Bayer HealthCare.

Prophylactic anticoagulation therapy after major orthopaedic surgeries is a standard practice to reduce the incidence of VTE. Enoxaparin, a factor Xa inhibitor, has been the prophylactic agent of choice after THR and TKR; however, its use is limited by the requirement for subcutaneous administration. In this regard, new agents such as rivaroxaban, an oral direct factor Xa inhibitor, appear to be promising candidates not affected by the limitations associated with parenteral administration of anticoagulants.

In RECORD 1 and 2, 35 days of oral rivaroxaban was compared with 35 days of subcutaneous (SC) enoxaparin (RECORD 1) or with 12 days of enoxaparin (RECORD 2) for THR, whereas, in RECORD 3, 1 2 days of oral rivaroxaban was compared with 12 days of SC enoxaparin for TKR. Compared with enoxaparin, rivaroxaban was associated with a 70% reduction in total VTE (composite: any deep-vein thrombosis, non-fatal pulmonary embolism or all-cause mortality) in RECORD 1, a 79% and 80% reduction in total and symptomatic VTE, respectively, in RECORD 2, and a 49% and 66% reduction in total and symptomatic VTE, respectively, in RECORD 3.

The five studies presented at the congress used data from the RECORD trials to evaluate the cost effectiveness of rivaroxaban in various healthcare settings. [1-5)

1.1 After Hip Surgery in Spain, Canada and the UK

The first study, conducted from a Spanish healthcare perspective, used a cost-utility model populated by RECORD 1 and 2 data to compare rivaroxaban with enoxaparin over 5 years [1] Treatment for 35 days with rivaroxaban was dominant over treatment for 35 days with enoxaparin with a cost saving of euro48.10 per patient and a small QALY gain, and was cost effective against the 12-day enoxaparin treatment with an incremental cost per QALY of euro3156. When both RECORD 1 and 2 data were combined, rivaroxaban remained dominant over enoxaparin with a QALY gain of 0.011 and a cost saving of euro12.24 per patient. Following sensitivity analyses, rivaroxaban was cost effective in 100% of cases and dominant in 60% of cases, compared with enoxaparin.

The second study was similar to the first, but it was conducted from a Canadian Ministry of Health perspective;[2] costs were expressed in $Can, year 2008 values, and included potential savings following oral administration. In this study too, rivaroxaban dominated the 35-day enoxaparin treatment with a cost saving of SCan282.58 per patient and a small QALY gain, and was cost effective against the 12-day enoxaparin treatment with an incremental cost per QALY of $Can33 323; reduced outpatient administration costs were a major contributing factor to the observed cost savings. In sensitivity analyses, rivaroxaban dominated enoxaparin in 98% of cases.

In the third study, conducted from a UK healthcare perspective, cost effectiveness of rivaroxaban versus enoxaparin was assessed over 5 years using RECORD 1 and 2 data.'3' Costs were expressed in £, year 2008 values, included potential savings associated with administration and monitoring. …

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