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    Cost-effectiveness of low-dose rivaroxaban and aspirin versus aspirin alone in people with peripheral or carotid artery disease: An Australian healthcare perspective

    Access Status
    Fulltext not available
    Authors
    Zomer, E.
    Si, S.
    Hird, T.
    Liew, D.
    Owen, A.
    Tonkin, A.
    Reid, Christopher
    Ademi, Z.
    Date
    2018
    Type
    Journal Article
    
    Metadata
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    Citation
    Zomer, E. and Si, S. and Hird, T. and Liew, D. and Owen, A. and Tonkin, A. and Reid, C. et al. 2018. Cost-effectiveness of low-dose rivaroxaban and aspirin versus aspirin alone in people with peripheral or carotid artery disease: An Australian healthcare perspective. European Journal of Preventive Cardiology. 26 (8): pp. 858–868.
    Source Title
    European Journal of Preventive Cardiology
    DOI
    10.1177/2047487318817910
    ISSN
    2047-4873
    School
    School of Public Health
    URI
    http://hdl.handle.net/20.500.11937/74837
    Collection
    • Curtin Research Publications
    Abstract

    Aims: Peripheral artery disease affects 1.2% of the population globally and is associated with an increased risk of atherothrombotic cardiovascular events, major adverse limb events and mortality. The Cardiovascular Outcomes for People Using Anti-coagulation Strategies (COMPASS) trial demonstrated positive results of rivaroxaban plus aspirin therapy compared to aspirin therapy alone in those with peripheral artery disease or carotid artery disease. We sought to estimate the cost-effectiveness from the Australian healthcare system perspective. Methods and results: A Markov model was developed to simulate the experiences of a hypothetical population of 1000 individuals with peripheral artery disease or carotid artery disease, profiled on the COMPASS trial, treated with rivaroxaban plus aspirin therapy versus aspirin therapy alone. With each annual cycle, individuals were at risk of having non-fatal cardiovascular disease events, major adverse limb events, or dying. Individuals were also at risk of non-fatal major bleeding. The model had a lifetime time horizon. Costs and utilities were sourced from the literature and discounted at 5.0% annually. Rivaroxaban plus aspirin therapy prevented 143 non-fatal cardiovascular disease events, 118 major adverse limb events and 10 deaths compared to aspirin therapy alone. Conversely, 156 additional major non-fatal bleeds were accrued. With an additional 256 quality-adjusted life years gained, at an additional cost of AUD$6,858,103, the incremental cost-effectiveness ratio was AUD$26,769 (discounted) per quality-adjusted life year gained, which is below Australia’s arbitrary willingness to pay threshold of AUD$50,000. Conclusion: In those with peripheral artery disease or carotid artery disease, rivaroxaban plus aspirin therapy is effective and cost-effective in the prevention of recurrent cardiovascular disease compared to aspirin therapy alone.

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