Cost-Consequence Analysis of Apixaban Versus Rivaroxaban for Managing Patients with Venous Thromboembolism in Saudi Arabia
Background and Objective Direct oral anticoagulants (DOACs) have been proven to be cost-effective for treating various conditions, including venous thromboembolism (VTE). Nevertheless, there are no studies assessing the cost-effectiveness of DOACs for VTE treatment in Saudi Arabia using real-world d...
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SAGE Publishing
2025-02-01
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| Series: | Clinical and Applied Thrombosis/Hemostasis |
| Online Access: | https://doi.org/10.1177/10760296251318705 |
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| author | Abdulaali R. Almutairi PhD Yazed Alruthia PhD Majed S. Alyami PharmD Omar A. Alshaya PharmD Taif Z. Alanazi PharmD Sarah I. Al Daghreer PharmD Ghazwa B. Korayem PharmD Sarah A. Alrasheed PharmD Reema A. Alorf PharmD Omar A. Almohammed PhD |
| author_facet | Abdulaali R. Almutairi PhD Yazed Alruthia PhD Majed S. Alyami PharmD Omar A. Alshaya PharmD Taif Z. Alanazi PharmD Sarah I. Al Daghreer PharmD Ghazwa B. Korayem PharmD Sarah A. Alrasheed PharmD Reema A. Alorf PharmD Omar A. Almohammed PhD |
| author_sort | Abdulaali R. Almutairi PhD |
| collection | DOAJ |
| description | Background and Objective Direct oral anticoagulants (DOACs) have been proven to be cost-effective for treating various conditions, including venous thromboembolism (VTE). Nevertheless, there are no studies assessing the cost-effectiveness of DOACs for VTE treatment in Saudi Arabia using real-world data. Hence, this study seeks to examine the costs and medical consequences of apixaban compared to rivaroxaban in treating VTE patients in Saudi Arabia. Methods A retrospective cohort study was carried out in three tertiary care hospitals spanning from January 2016 to December 2020. The measure of effectiveness is defined as the likelihood of preventing the composite of VTE recurrence (rVTE), major bleeding (MB), or clinically relevant non-major bleeding (CRNMB) within 90 days of the indexed VTE event, and rehospitalization due to rVTE, MB, or CRNMB. The effectiveness was determined by calculating 1 minus the probability of experiencing the composite outcome. The incremental cost-effectiveness ratio (ICER) was computed from the perspective of the Saudi National Health System, therefore only direct costs were considered. The 95% confidence interval surrounding mean costs and effectiveness rates was calculated using the bootstrapping method. Sensitivity analyses were also carried out. Results In the analysis, 367 patients were included, with 176 on apixaban and 191 on rivaroxaban. The average annual medication costs for apixaban and rivaroxaban were $547.05 and $577.77, respectively. The mean annual direct medical costs for apixaban and rivaroxaban were $6496.83 (95%CI 5748.86-7457.97) and $5528.58 (95%CI 4836.21-6024.52), respectively. Apixaban's and rivaroxaban's mean effectiveness rates were 0.91 (95%CI 0.87-0.96) and 0.77 (95%CI 0.71-0.83), respectively. This resulted in an ICER of $6916.07 for the prevention of an additional composite outcome when using apixaban instead of rivaroxaban. The use of apixaban for preventing composite outcomes has been found to be more effective but costlier in 94.81% of the bootstrap cost-effectiveness distributions compared to rivaroxaban. It was also found to be more effective and less costly in 5.19% of the bootstrap cost-effectiveness distributions. Conclusion Apixaban demonstrated superiority over rivaroxaban in preventing composite outcomes, encompassing rVTE, MB, CRNMB, and rehospitalization. Nevertheless, this was correlated with increased direct medical expenses. These findings emphasize the necessity of a well-rounded approach when choosing anticoagulants, considering both clinical effectiveness and economic considerations. This study's results are impactful for improving patient care and resource allocation, underscoring the pivotal role of cost-effectiveness in healthcare decision-making. |
| format | Article |
| id | doaj-art-b18341db4e6a460ba52e071ce31eb112 |
| institution | Kabale University |
| issn | 1938-2723 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Clinical and Applied Thrombosis/Hemostasis |
| spelling | doaj-art-b18341db4e6a460ba52e071ce31eb1122025-02-03T05:03:25ZengSAGE PublishingClinical and Applied Thrombosis/Hemostasis1938-27232025-02-013110.1177/10760296251318705Cost-Consequence Analysis of Apixaban Versus Rivaroxaban for Managing Patients with Venous Thromboembolism in Saudi ArabiaAbdulaali R. Almutairi PhD0Yazed Alruthia PhD1Majed S. Alyami PharmD2Omar A. Alshaya PharmD3Taif Z. Alanazi PharmD4Sarah I. Al Daghreer PharmD5Ghazwa B. Korayem PharmD6Sarah A. Alrasheed PharmD7Reema A. Alorf PharmD8Omar A. Almohammed PhD9 Drug Sector, , Riyadh, Saudi Arabia Pharmacoeconomics Research Unit, College of Pharmacy, , Riyadh, Saudi Arabia Pharmaceutical Care Department, , Riyadh, Saudi Arabia Pharmaceutical Care Department, , Riyadh, Saudi Arabia Department of Pharmacy Practice, , Riyadh, Saudi Arabia Department of Pharmacy Practice, , Riyadh, Saudi Arabia Department of Pharmacy Practice, College of Pharmacy, , Riyadh, Saudi Arabia Department of Clinical Pharmacy, , Riyadh, Saudi Arabia Department of Clinical Pharmacy, , Riyadh, Saudi Arabia Pharmacoeconomics Research Unit, College of Pharmacy, , Riyadh, Saudi ArabiaBackground and Objective Direct oral anticoagulants (DOACs) have been proven to be cost-effective for treating various conditions, including venous thromboembolism (VTE). Nevertheless, there are no studies assessing the cost-effectiveness of DOACs for VTE treatment in Saudi Arabia using real-world data. Hence, this study seeks to examine the costs and medical consequences of apixaban compared to rivaroxaban in treating VTE patients in Saudi Arabia. Methods A retrospective cohort study was carried out in three tertiary care hospitals spanning from January 2016 to December 2020. The measure of effectiveness is defined as the likelihood of preventing the composite of VTE recurrence (rVTE), major bleeding (MB), or clinically relevant non-major bleeding (CRNMB) within 90 days of the indexed VTE event, and rehospitalization due to rVTE, MB, or CRNMB. The effectiveness was determined by calculating 1 minus the probability of experiencing the composite outcome. The incremental cost-effectiveness ratio (ICER) was computed from the perspective of the Saudi National Health System, therefore only direct costs were considered. The 95% confidence interval surrounding mean costs and effectiveness rates was calculated using the bootstrapping method. Sensitivity analyses were also carried out. Results In the analysis, 367 patients were included, with 176 on apixaban and 191 on rivaroxaban. The average annual medication costs for apixaban and rivaroxaban were $547.05 and $577.77, respectively. The mean annual direct medical costs for apixaban and rivaroxaban were $6496.83 (95%CI 5748.86-7457.97) and $5528.58 (95%CI 4836.21-6024.52), respectively. Apixaban's and rivaroxaban's mean effectiveness rates were 0.91 (95%CI 0.87-0.96) and 0.77 (95%CI 0.71-0.83), respectively. This resulted in an ICER of $6916.07 for the prevention of an additional composite outcome when using apixaban instead of rivaroxaban. The use of apixaban for preventing composite outcomes has been found to be more effective but costlier in 94.81% of the bootstrap cost-effectiveness distributions compared to rivaroxaban. It was also found to be more effective and less costly in 5.19% of the bootstrap cost-effectiveness distributions. Conclusion Apixaban demonstrated superiority over rivaroxaban in preventing composite outcomes, encompassing rVTE, MB, CRNMB, and rehospitalization. Nevertheless, this was correlated with increased direct medical expenses. These findings emphasize the necessity of a well-rounded approach when choosing anticoagulants, considering both clinical effectiveness and economic considerations. This study's results are impactful for improving patient care and resource allocation, underscoring the pivotal role of cost-effectiveness in healthcare decision-making.https://doi.org/10.1177/10760296251318705 |
| spellingShingle | Abdulaali R. Almutairi PhD Yazed Alruthia PhD Majed S. Alyami PharmD Omar A. Alshaya PharmD Taif Z. Alanazi PharmD Sarah I. Al Daghreer PharmD Ghazwa B. Korayem PharmD Sarah A. Alrasheed PharmD Reema A. Alorf PharmD Omar A. Almohammed PhD Cost-Consequence Analysis of Apixaban Versus Rivaroxaban for Managing Patients with Venous Thromboembolism in Saudi Arabia Clinical and Applied Thrombosis/Hemostasis |
| title | Cost-Consequence Analysis of Apixaban Versus Rivaroxaban for Managing Patients with Venous Thromboembolism
in Saudi Arabia |
| title_full | Cost-Consequence Analysis of Apixaban Versus Rivaroxaban for Managing Patients with Venous Thromboembolism
in Saudi Arabia |
| title_fullStr | Cost-Consequence Analysis of Apixaban Versus Rivaroxaban for Managing Patients with Venous Thromboembolism
in Saudi Arabia |
| title_full_unstemmed | Cost-Consequence Analysis of Apixaban Versus Rivaroxaban for Managing Patients with Venous Thromboembolism
in Saudi Arabia |
| title_short | Cost-Consequence Analysis of Apixaban Versus Rivaroxaban for Managing Patients with Venous Thromboembolism
in Saudi Arabia |
| title_sort | cost consequence analysis of apixaban versus rivaroxaban for managing patients with venous thromboembolism in saudi arabia |
| url | https://doi.org/10.1177/10760296251318705 |
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