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

Caroline Cândida Carvalho de Oliveira, Leandro Barile Agati, Camilla Moreira Ribeiro, Valéria Cristina Resende Aguiar, Roberto Augusto Caffaro, Marisa da Silva Santos, Ricardo Ribeiro Alves Fernandes, Carlos Alberto da Silva Magliano, Alfonso Tafur, Alex C. Spyropoulos, Renato Delascio Lopes, Jawed Fareed, Eduardo Ramacciotti

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

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. Funding: Modest funding was provided by Science Valley Research Institute, São Paulo, Brazil.

Original languageEnglish
Article number100543
JournalThe Lancet Regional Health - Americas
Volume24
DOIs
StatePublished - Aug 2023
Externally publishedYes

Keywords

  • Anticoagulation
  • COVID
  • Cost-effectiveness analysis
  • Direct oral anticoagulants
  • Thromboprophylaxis
  • Thrombosis

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