Cost-effectiveness analysis of extended thromboprophylaxis with rivaroxaban versus no prophylaxis in high-risk patients after hospitalisation for COVID-19: an economic modelling study
Cost-effectiveness analysis of extended thromboprophylaxis with rivaroxaban versus no prophylaxis in high-risk patients after hospitalisation for COVID-19: an economic modelling study
Data
2023
Autores
Oliveira, Caroline Cândida Carvalho de
Agati, Leandro Barile
Ribeiro, Camilla Moreira
Aguiar, Valéria Cristina Resende
Caffaro, Roberto Augusto
Santos, Marisa da Silva
Fernandes, Ricardo Ribeiro Alves
Magliano, Carlos Alberto da Silva
Tafur, Alfonso
Spyropoulos, Alex C.
Journal Title
Journal ISSN
Volume Title
Publisher
The Lancet
Resumo
Background In patients at high risk of thromboembolism who were discharged after hospitalisation due to COVID-19,
thromboprophylaxis with rivaroxaban 10 mg/day for 35 days significantly improved clinical outcomes, reducing
thrombotic events compared with no post-discharge anticoagulation. The present study aimed to estimate the cost-
effectiveness of this anticoagulation strategy.
Methods Using the database of the MICHELLE trial, we developed a decision tree to estimate the cost-effectiveness of
thromboprophylaxis with rivaroxaban 10 mg/day for 35 days versus no thromboprophylaxis in high-risk post-
discharge patients for COVID-19 through an incremental cost-effectiveness analysis.
Findings 318 patients in 14 centres in Brazil were enrolled in the primary MICHELLE trial. The mean age was 57.1
years (SD 15.2), 127 (40%) were women, 191 (60%) were men, and the mean body-mass index was 29.7 kg/m2 (SD
5.6). Rivaroxaban 10 mg per day orally for 35 days after discharge decreased the risk of events defined by the primary
efficacy outcome by 67% (relative risk 0.33, 95% CI 0.12–0.90; p = 0.03). The mean cost for thromboprophylaxis with
rivaroxaban was $53.37/patient, and no prophylaxis was $34.22/patient, with an incremental cost difference of
$19.15. The effectiveness means obtained in the intervention group was 0.1457, while in the control group was
0.1421, determining an incremental QALY difference of 0.0036. The estimated incremental cost-effectiveness ratio
(ICER) was $5385.52/QALY.
Interpretation Extended treatment with Rivaroxaban as thromboprophylaxis after hospital discharge for high-risk
patients with COVID-19 is a cost-effective treatment option.
Description
Palavras-chave
Thromboprophylaxis, COVID, Anticoagulation, Cost-effectiveness analysis, Direct oral anticoagulants, Thrombosis
Citação
Carvalho de Oliveira CC, Agati LB, Ribeiro CM, Resende Aguiar VC, Caffaro RA, da Silva Santos M, Alves Fernandes RR, Alberto da Silva Magliano C, Tafur A, Spyropoulos AC, Lopes RD, Fareed J, Ramacciotti E. Cost-effectiveness analysis of extended thromboprophylaxis with rivaroxaban versus no prophylaxis in high-risk patients after hospitalisation for COVID-19: an economic modelling study. Lancet Reg Health Am. 2023 Aug;24:100543. doi: 10.1016/j.lana.2023.100543