Cost-effectiveness and budget impact analysis of rivaroxaban with or without aspirin compared to aspirin alone in patients with coronary and peripheral artery diseases in Iran
Abstract Background Low-dose aspirin and rivaroxaban are the cornerstone treatment for cardiovascular prevention in patients with peripheral artery disease (PAD) and/or stable coronary artery disease (SCAD). The combination of rivaroxaban with aspirin imposes a synergistic effect on the inhibition o...
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| Format: | Article |
| Language: | English |
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BMC
2025-03-01
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| Series: | BMC Health Services Research |
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| Online Access: | https://doi.org/10.1186/s12913-025-12431-3 |
| _version_ | 1826560308871692288 |
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| author | Zahra Goudarzi Zhila Najafpour Ahmad Gholami Khosro Keshavarz Mohammad Mahdi Mojahedian Mohammad Mehdi Babayi |
| author_facet | Zahra Goudarzi Zhila Najafpour Ahmad Gholami Khosro Keshavarz Mohammad Mahdi Mojahedian Mohammad Mehdi Babayi |
| author_sort | Zahra Goudarzi |
| collection | DOAJ |
| description | Abstract Background Low-dose aspirin and rivaroxaban are the cornerstone treatment for cardiovascular prevention in patients with peripheral artery disease (PAD) and/or stable coronary artery disease (SCAD). The combination of rivaroxaban with aspirin imposes a synergistic effect on the inhibition of factor-induced platelet aggregation. The present work aimed at comparing the cost-utility and cost-effectiveness of rivaroxaban (2.5 mg twice daily) plus aspirin (100 mg once daily), rivaroxaban alone (5 mg twice daily) with aspirin alone in patients with peripheral artery disease (PAD) or coronary artery disease (CAD) and related subgroups. Methods This pharmacoeconomic study was performed based on the insurance organization and utilized a state-transition decision Markov model. From the COMPASS trial, Clinical efficacy and Clinical events were collected. Health outcomes and cost were assessed over a 20-year time horizon (lifetime). The direct costs of medical services were included in the analysis. The results were stated based on Incremental Cost-Utility (ICUR) and Incremental Cost Effectiveness Ratio (ICER). Uncertainty was assessed utilizing deterministic and probabilistic sensitivity analyses. Discount rates of .058 and .03 were included for cost and effectiveness data, respectively. The budget impact based on the Markov model was estimated as the financial burden resulting from the insurance coverage of rivaroxaban. Results In the total of CAD and PAD patients, treatment with rivaroxaban plus aspirin and rivaroxaban alone were more expensive than the aspirin alone, but also more effective, resulting in ICUR being $4594/QALY and $13601/QALY respectively, and for ICER being $3348/LYG and $9901/LYG. In PAD patients rivaroxaban plus aspirin had higher effectiveness than aspirin alone that ICUR and ICER being $11929/QALY and $9896/LYG respectively. In CAD patients, treatment with rivaroxaban plus aspirin was expensive and less effective than aspirin alone. The estimated annual budget impact was $28,253,135 for the rivaroxaban plus aspirin and $292,593,909 for the rivaroxaban alone in the total of CAD and PAD patients. Conclusions This study showed that rivaroxaban plus aspirin is a cost-effective alternative in PAD and total of CAD and PAD patients. In CAD patients, rivaroxaban plus aspirin and rivaroxaban alone were not cost-effective. |
| first_indexed | 2025-03-14T09:14:13Z |
| format | Article |
| id | doaj.art-9826d38b29d9450c8d9eaf83db6d21ed |
| institution | Directory Open Access Journal |
| issn | 1472-6963 |
| language | English |
| last_indexed | 2025-03-14T09:14:13Z |
| publishDate | 2025-03-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj.art-9826d38b29d9450c8d9eaf83db6d21ed2025-03-02T12:18:43ZengBMCBMC Health Services Research1472-69632025-03-0125111210.1186/s12913-025-12431-3Cost-effectiveness and budget impact analysis of rivaroxaban with or without aspirin compared to aspirin alone in patients with coronary and peripheral artery diseases in IranZahra Goudarzi0Zhila Najafpour1Ahmad Gholami2Khosro Keshavarz3Mohammad Mahdi Mojahedian4Mohammad Mehdi Babayi5Health Human Resources Research Center, Department of Health Economics, School of Health Management and Information Sciences, Shiraz University of Medical SciencesDepartment of Health Care Management, School of Public Health, Ahvaz Jundishapur University of Medical SciencesPharmaceutical Sciences Research Center, Faculty of Pharmacy, Shiraz University of Medical SciencesHealth Human Resources Research Center, Department of Health Economics, School of Health Management and Information Sciences, Shiraz University of Medical SciencesDepartment of Clinical Pharmacy and Pharmacoeconomics, School of Pharmacy, Iran University of Medical SciencesFaculty of Pharmacy, Shiraz University of Medical SciencesAbstract Background Low-dose aspirin and rivaroxaban are the cornerstone treatment for cardiovascular prevention in patients with peripheral artery disease (PAD) and/or stable coronary artery disease (SCAD). The combination of rivaroxaban with aspirin imposes a synergistic effect on the inhibition of factor-induced platelet aggregation. The present work aimed at comparing the cost-utility and cost-effectiveness of rivaroxaban (2.5 mg twice daily) plus aspirin (100 mg once daily), rivaroxaban alone (5 mg twice daily) with aspirin alone in patients with peripheral artery disease (PAD) or coronary artery disease (CAD) and related subgroups. Methods This pharmacoeconomic study was performed based on the insurance organization and utilized a state-transition decision Markov model. From the COMPASS trial, Clinical efficacy and Clinical events were collected. Health outcomes and cost were assessed over a 20-year time horizon (lifetime). The direct costs of medical services were included in the analysis. The results were stated based on Incremental Cost-Utility (ICUR) and Incremental Cost Effectiveness Ratio (ICER). Uncertainty was assessed utilizing deterministic and probabilistic sensitivity analyses. Discount rates of .058 and .03 were included for cost and effectiveness data, respectively. The budget impact based on the Markov model was estimated as the financial burden resulting from the insurance coverage of rivaroxaban. Results In the total of CAD and PAD patients, treatment with rivaroxaban plus aspirin and rivaroxaban alone were more expensive than the aspirin alone, but also more effective, resulting in ICUR being $4594/QALY and $13601/QALY respectively, and for ICER being $3348/LYG and $9901/LYG. In PAD patients rivaroxaban plus aspirin had higher effectiveness than aspirin alone that ICUR and ICER being $11929/QALY and $9896/LYG respectively. In CAD patients, treatment with rivaroxaban plus aspirin was expensive and less effective than aspirin alone. The estimated annual budget impact was $28,253,135 for the rivaroxaban plus aspirin and $292,593,909 for the rivaroxaban alone in the total of CAD and PAD patients. Conclusions This study showed that rivaroxaban plus aspirin is a cost-effective alternative in PAD and total of CAD and PAD patients. In CAD patients, rivaroxaban plus aspirin and rivaroxaban alone were not cost-effective.https://doi.org/10.1186/s12913-025-12431-3Cost-effectivenessCost-utilityCADPADRivaroxabanAspirin |
| spellingShingle | Zahra Goudarzi Zhila Najafpour Ahmad Gholami Khosro Keshavarz Mohammad Mahdi Mojahedian Mohammad Mehdi Babayi Cost-effectiveness and budget impact analysis of rivaroxaban with or without aspirin compared to aspirin alone in patients with coronary and peripheral artery diseases in Iran BMC Health Services Research Cost-effectiveness Cost-utility CAD PAD Rivaroxaban Aspirin |
| title | Cost-effectiveness and budget impact analysis of rivaroxaban with or without aspirin compared to aspirin alone in patients with coronary and peripheral artery diseases in Iran |
| title_full | Cost-effectiveness and budget impact analysis of rivaroxaban with or without aspirin compared to aspirin alone in patients with coronary and peripheral artery diseases in Iran |
| title_fullStr | Cost-effectiveness and budget impact analysis of rivaroxaban with or without aspirin compared to aspirin alone in patients with coronary and peripheral artery diseases in Iran |
| title_full_unstemmed | Cost-effectiveness and budget impact analysis of rivaroxaban with or without aspirin compared to aspirin alone in patients with coronary and peripheral artery diseases in Iran |
| title_short | Cost-effectiveness and budget impact analysis of rivaroxaban with or without aspirin compared to aspirin alone in patients with coronary and peripheral artery diseases in Iran |
| title_sort | cost effectiveness and budget impact analysis of rivaroxaban with or without aspirin compared to aspirin alone in patients with coronary and peripheral artery diseases in iran |
| topic | Cost-effectiveness Cost-utility CAD PAD Rivaroxaban Aspirin |
| url | https://doi.org/10.1186/s12913-025-12431-3 |
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