Cost-effectiveness analysis of extended thromboprophylaxis with rivaroxaban versus no prophylaxis in high-risk patients after hospitalisation for COVID-19: an economic modelling study

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dc.contributor.authorOliveira, Caroline Cândida Carvalho de
dc.contributor.authorAgati, Leandro Barile
dc.contributor.authorRibeiro, Camilla Moreira
dc.contributor.authorAguiar, Valéria Cristina Resende
dc.contributor.authorCaffaro, Roberto Augusto
dc.contributor.authorSantos, Marisa da Silva
dc.contributor.authorFernandes, Ricardo Ribeiro Alves
dc.contributor.authorMagliano, Carlos Alberto da Silva
dc.contributor.authorTafur, Alfonso
dc.contributor.authorSpyropoulos, Alex C.
dc.contributor.authorLopes, Renato Delascio
dc.contributor.authorFareed, Jawed
dc.contributor.authorRamacciottia, Eduardo
dc.date.accessioned2024-10-04T18:38:16Z
dc.date.available2024-10-04T18:38:16Z
dc.date.issued2023
dc.description.abstractBackground 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.
dc.identifier.citationCarvalho 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
dc.identifier.otherDOI: 10.1016/j.lana.2023.100543
dc.identifier.urihttps://dspace.inc.saude.gov.br/handle/123456789/470
dc.language.isoen
dc.publisherThe Lancet
dc.subjectThromboprophylaxisen
dc.subjectCOVIDen
dc.subjectAnticoagulationen
dc.subjectCost-effectiveness analysisen
dc.subjectDirect oral anticoagulantsen
dc.subjectThrombosisen
dc.titleCost-effectiveness analysis of extended thromboprophylaxis with rivaroxaban versus no prophylaxis in high-risk patients after hospitalisation for COVID-19: an economic modelling study
dc.typeArticle
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