Health Economics — Potential for Significant Cost Savings with Xarelto®
The high cost of treating symptomatic venous thromboembolism
(VTE) is the most frequent serious complication following elective hip and knee replacement surgery. In addition to the initial event, longer-term complications such as recurrent VTE
and post-thrombotic syndrome are possible.11
causes over 500,000 deaths in Europe every year.
As the leading cause of rehospitalisation after elective hip and knee replacement surgery, VTE
also represents a major impact on health care resources. The total annual cost of managing VTE
after major orthopaedic surgery
in Europe in 2006 was estimated as €8,265 per patient.12
This cost is primarily driven by inpatient management and follow-up care.
Finally, the impact of VTE
on the quality of life of patients and families should not be underestimated. These factors — the clinical, economic, and humanistic impacts of VTE
— are why primary prevention of VTE
is recommended for all patients undergoing elective hip and knee replacement surgery.
The potential economic benefit of preventive therapy with Xarelto compared to enoxaparin
A recent analysis indicates that thromboprophylaxis
with Xarelto compared to enoxaparin can realise significant cost savings per patient, with marked cost savings for health care systems.13
The RECORD3 study showed that symptomatic VTE
after elective total knee replacement surgery was significantly lower in rivaroxaban patients (0.7%) than in enoxaparin patients (2.0%). In addition to these clinical benefits, however, significant economic benefits can be achieved because of the reduced need to treat symptomatic events.
Potential for significant savings per patient are attainable with Xarelto
In the initial analysis, the costs of managing symptomatic VTE
in the US and UK were applied to the incidence of symptomatic VTE
after elective total knee replacement (based on RECORD3). This resulted in per-patient cost savings of $139.41 in the US and £11.76 in the UK.
Furthermore, rivaroxaban is an oral prophylaxis requiring no assistance with administration. A small proportion of patients receiving subcutaneous
enoxaparin, however, require daily outpatient nursing assistance to remain compliant. When the costs of this nursing assistance are considered, the potential per-patient cost savings with rivaroxaban following elective total knee replacement rose to $149.91 in the US and £36.76 in the UK.
Additional potential savings with Xarelto
The analysis may underestimate the actual savings from treatment with Xarelto because it did not factor in that oral, once-daily dosing with Xarelto may also enhance compliance and adherence to guideline-recommended treatment, and may reduce VTE
events in the long term.
- 11 - Prandoni P, Noventa F, Ghirarduzzi A, et al. The risk of recurrent venous thromboembolism after discontinuing anticoagulation in patients with acute proximal deep vein thrombosis or pulmonary embolism. A prospective cohort study in 1,626 patients. Haematologica. 2007;92(2):199-205.
- 12 - Tilleul P, LaFuma A, Colin X, Ozier Y. Estimated annual costs of prophylaxis and treatment of venous thromboembolic events associated with major orthopedic surgery in France. Clin Appl Thromb Hemost. 2006;12(4):473-484.
- 13 - Lees M, Sengupta N. Economic impact of venous thromboembolism prophylaxis with rivaroxaban after major orthopaedic surgery. Poster P082 presented at: 20th International Congress on Thrombosis (ICT), June 25-28, 2008; Athens, Greece.
- Venous thromboembolism
- A disease process beginning with a blood clot occurring within the venous system, including deep vein thrombosis and pulmonary embolism.
- Major orthopaedic surgery
- Major operations on the bones or joints including total hip or knee replacement surgery.
- Preventative treatment for blood clotting.
- Introduced beneath the skin.