Rivaroxaban in VTE: Lower Clinical Event Costs, But Higher Healthcare Costs

Venous Thrombosis
Venous Thrombosis
Rivaroxaban was associated with lower clinical event costs but higher total healthcare costs compared with aspirin in patients with venous thromboembolism.

Treatment with rivaroxaban at 10 mg and 20 mg doses in patients with venous thromboembolism (VTE) was associated with lower clinical event costs and higher total healthcare costs compared with aspirin, according to a study published in CHEST.

In the previously published EINSTEIN-CHOICE (ClinicalTrials.gov Identifier: NCT02064439) study, 3365 patients with VTE and prior 6- to 12-month anticoagulant treatment were treated with once-daily 10 mg rivaroxaban (n=1127), 20 mg rivaroxaban (n=1107), or 100 mg aspirin (n=1131). Researchers sought to compare total healthcare direct costs, defined as the drug cost plus clinical event cost, associated with extended rivaroxaban vs aspirin during a 1-year period. Clinical event costs were defined as the cost of care for a clinical event except for death.

Patients who received both doses of rivaroxaban had lower clinical event costs per month compared with aspirin users ($123 [10 mg] and $243 [20 mg] vs $381 [aspirin]). The per patient per month total healthcare costs, however, were higher in patients treated with 10 mg and 20 mg rivaroxaban by $24 and $143, respectively, driven primarily by the higher cost of treatment compared with aspirin. According to the investigators, applying a 15% discount to 10 mg rivaroxaban resulted in lower clinical event costs, which offset the higher drug costs, subsequently resulting in a $19 lower total healthcare cost.

A limitation of the analysis is the lack of assessment of other secondary outcomes, such as stroke, which directly affect healthcare costs in people with VTE.

In addition, the unit cost assumptions were based on the US healthcare system, but the EINSTEIN-CHOICE trial was conducted in an international system; therefore, the differences may have affected the results, the investigators explained.

Related Articles

Disclosures: This research was funded by Janssen Scientific Affairs, LLC, and several authors are employees of Janssen Scientific Affairs, LLC and Janssen Research & Development, LLC.


Wells PS, Prins MH, Beyer-Westendorf J, et al. Healthcare cost impact of continued anticoagulation with rivaroxaban versus aspirin for prevention of recurrent symptomatic venous thromboembolism in the EINSTEIN-CHOICE Trial population [published September 7, 2018]. CHEST. doi:10.1016/j.chest.2018.08.1059