A multi-perspective cost-effectiveness analysis comparing rivaroxaban with enoxaparin sodium for thromboprophylaxis after total hip and knee replacement in the German healthcare setting

Zindel, Sonja; Stock, Stephanie; Müller, Dirk; Stollenwerk, Björn

doi:10.1186/1472-6963-12-192

Cited by 22 publications

(17 citation statements)

References 29 publications

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“…The perspective of cost measurement is known to greatly influence the results [32], [33]. This analysis was performed from the statutory health insurance perspective, and thus indirect costs have not been included.…”

Section: Discussionmentioning

confidence: 99%

Breast Cancer Attributable Costs in Germany: A Top-Down Approach Based on Sickness Funds Data

2012

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BackgroundBreast cancer is the leading cause of death from cancer among women in Germany. Despite its clinical and economic relevance, no attributable costs for breast cancer have been reported for Germany so far. The objective of this study is to estimate age-specific breast cancer attributable health expenditures for Germany.MethodsSickness fund data from 1999 representing about 26 million insured (i.e. 32% of the total German population) have been analysed using generalized additive models and the error propagation law. Costs have been inflated to 2010.ResultsBreast cancer attributable costs decreased with age. Among breast cancer patients aged 30–45 years, about 90% of all health expenditures were due to breast cancer, whereas in breast cancer patients aged 80–90 years, about 50% were due to breast cancer. Breast cancer attributable costs amounted to about €9,000 annually for patients below 55 years of age and declined to about €3,000 in 90-year-old breast cancer patients.ConclusionThis analysis provides estimates of attributable breast cancer costs in Germany. Compared with the international literature, the estimates were plausible but had a tendency to underestimate breast cancer attributable costs.

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Section: Discussionmentioning

confidence: 99%

Breast Cancer Attributable Costs in Germany: A Top-Down Approach Based on Sickness Funds Data

2012

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“…There is a wide range of measures to cure or prevent CVD [10], [11], [12]. The burden of CVD may be reduced by guaranteeing medical treatment to a large proportion of the population, by setting up evidence-based treatment guidelines and by establishing incentives that encourage health professionals to follow these [13], [14]. Additionally, educating the population about risk factors and enhancing early detection are valuable measures [10], [13].…”

Section: Introductionmentioning

confidence: 99%

The Association between Health System Development and the Burden of Cardiovascular Disease: An Analysis of WHO Country Profiles

2013

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BackgroundSeveral risk factors for cardiovascular disease (CVD) have been identified in recent decades. However, the association between the health system and the burden of CVD has not yet been sufficiently researched. The objective of this study was to analyse the association between health system development and the burden of CVD, in particular CVD-related disability-adjusted life–years (DALYs).MethodsUnivariate and multivariate generalized linear mixed models were applied to country-level data collected by the World Bank and World Health Organization. Response variables were the age-standardized CVD mortality and age-standardized CVD DALY rates.ResultsThe amount of available health system resources, indicated by total health expenditures per capita, physician density, nurse density, dentistry density, pharmaceutical density and the density of hospital beds, was associated with reduced CVD DALY rates and CVD mortality. However, in the multivariate models, the density of nurses and midwives was positively associated with CVD. High out-of-pocket costs were associated with increased CVD mortality in both univariate and multivariate analyses.ConclusionA highly developed health system with a low level of out-of-pocket costs seems to be the most appropriate to reduce the burden of CVD. Furthermore, an efficient balance between human health resources and health technologies is essential.

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“…LMWH cumulatively affect the kidneys, and are associated with the risk of heparin-induced thrombocytopenia. 7 From a practical pointofview, enoxaparin is administered by subcutaneous injection, therefore, it requires patient training for postdischarge self-administration or home administration by a health care professional. Furthermore, the treatment with enoxaparin must begin 12 hours before surgery 6 , and needs dose adjustment in case of extreme weight values.…”

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“…Furthermore, the treatment with enoxaparin must begin 12 hours before surgery 6 , and needs dose adjustment in case of extreme weight values. 7 Conversely, new oral anticoagulants offer several advantages over enoxaparin, such as an easy route of administration as they are given orally, they are not administered before surgery, do not require routine monitoring (coagulation or platelet count) and do not need dose adjustments. 7 Rivaroxaban is an oral direct factor Xa inhibitor that has shown superior efficacy and similar safety profile compared to enoxaparin regimens for the prevention of VTE in patients undergoing elective THR or TKR surgery in randomized clinical trials (RCTs; RECORD 1, 2, 3 and 4 trials).…”

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confidence: 99%

“…7 Conversely, new oral anticoagulants offer several advantages over enoxaparin, such as an easy route of administration as they are given orally, they are not administered before surgery, do not require routine monitoring (coagulation or platelet count) and do not need dose adjustments. 7 Rivaroxaban is an oral direct factor Xa inhibitor that has shown superior efficacy and similar safety profile compared to enoxaparin regimens for the prevention of VTE in patients undergoing elective THR or TKR surgery in randomized clinical trials (RCTs; RECORD 1, 2, 3 and 4 trials). [8][9][10][11] However, RCT results are often biased due to the selection of the study population, therefore, observational phase IV studies can provide insights of the real-world effectiveness of therapies.…”

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Budget Impact of Rivaroxaban for the Prevention of Thromboembolic Events after Hip or Knee Replacement in Spain

Xiberta

Murcia

Durán

et al. 2016

JHEOR

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Background: Anti-thrombotic prophylaxis is routinely used in patients undergoing elective total hip or knee replacement (THR or TKR) to reduce the risk of venous thromboembolism (VTE). In Spain, pharmacological prophylaxis is performed with low-molecular-weight heparin, enoxaparin being the most commonly used. Rivaroxaban is an oral antithrombotic drug that has shown superior efficacy and similar safety profile compared to enoxaparin regimens in randomized clinical trials. The aim of the study was to estimate the budget impact of increasing the use of rivaroxaban with respect to enoxaparin in the prophylaxis of VTE in patients undergoing elective THR or TKR. Methods: A budget impact analysis was conducted in order to estimate the economic cost from an increase of rivaroxaban use versus enoxaparin by 10%, 20%, and 30% over the 3 years of the time horizon (2015, 2016, and 2017) for the THR and TKR populations. Data related to rate of thromboembolic events, major bleeding events and use of resources (local or general anesthesia and nurse care after surgery) were obtained from the Xarelto® for VTE Prophylaxis After Hip or Knee Arthroplasty (XAMOS) study, an international, non-interventional, observational, open-label study in unselected patients undergoing THR or TKR surgery in routine practice. The study included a total of 17 701 patients from 252 centers in 37 countries, including Spain, Italy, France and United Kingdom, among others. Two cohorts where considered (patients undergoing THR or TKR) with two arms (patients treated with rivaroxaban or enoxaparin). The Spanish patients enrolled in the XAMOS study were 262 with THR and 538 with TKR. Thromboembolic events, major bleeding rates and health care resources were considered from both the international and the Spanish population. Health care resources including pharmacologic prophylaxis, anesthesia and nurse care costs (Euros 2014) were estimated from the Spanish National Healthcare System (NHS) perspective. The annual cost associated with each cohort was estimated based on the mean cost per patient and the estimated distribution of use of rivaroxaban or enoxaparin in the base case scenario and alternative scenario (increase of rivaroxaban use) over the 3 years. A one-way sensitivity analysis was conducted to evaluate the effect that the uncertainty of the input parameters may have on the results of the impact budget. Results: The difference in cost per patient undergoing THR or TKR with rivaroxaban versus enoxaparin was -€140.69 including event rates and resource use from the Spanish XAMOS population, and -€110.54 when considering event rates and resource use from the multinational XAMOS population (including but not limited to European [Spain, France, Italy, United Kingdom, Portugal, etc.], American [Canada, Mexico, Colombia, Venezuela, etc.], Asian [China, etc.] and Australian countries). In the analysis per cohort (THR or TKR), the impact of increasing the use of rivaroxaban in the THR cohort, was -€1106, -€2875, and -€5607 for 2015, 2016, and 2017, considering the data from the Spanish XAMOS population, and -€869, -€2259, and -€4405 considering the data from the multinational population. Considering the TKR cohort, the impact was -€2271, -€5904, and -€11 513, and -€1784, €4639, and -€9046, respectively. Conclusions: The present analysis shows that, according to effectiveness data from the XAMOS study (Spanish and multinational cohorts), an increase in the usage of rivaroxaban in VTE prophylaxis would lead to significant direct cost reduction in elective THR and TKR patients.

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A multi-perspective cost-effectiveness analysis comparing rivaroxaban with enoxaparin sodium for thromboprophylaxis after total hip and knee replacement in the German healthcare setting

Cited by 22 publications

References 29 publications

Breast Cancer Attributable Costs in Germany: A Top-Down Approach Based on Sickness Funds Data

Breast Cancer Attributable Costs in Germany: A Top-Down Approach Based on Sickness Funds Data

The Association between Health System Development and the Burden of Cardiovascular Disease: An Analysis of WHO Country Profiles

Budget Impact of Rivaroxaban for the Prevention of Thromboembolic Events after Hip or Knee Replacement in Spain

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