Price Analysis

Table 4 provides a summary of the impact of a price reduction on the likely cost savings associated with rivaroxaban at 12 and 26 months, based on the manufacturer’s assumptions concerning cost of care and monitoring. A price reduction of about 20% would be required to realize cost savings for 12 months of therapy and a price reduction of about 50% would be required to realize savings during 36-month treatment duration.

Table 4

CADTH Common Drug Review Analysis for Price Reduction Scenarios for Rivaroxaban (12 to 36 Months of Treatment Duration).

Additional Reanalyses

CDR also performed a reanalysis on monitoring-cost scenarios to determine the threshold at which rivaroxaban is no longer cost saving at three or six months. Two specific scenarios were looked at: one in which the frequency of monitoring during the first three months was reduced (base case assumed eight visits with attendant testing; Table 5) and a second scenario in which a larger proportion of patients were monitoring through an anticoagulation clinic (where the cost per consultation and attendant testing was estimated to be lower than GP-based monitoring; Table 6).

Table 5

CADTH Common Drug Review Analysis for Monitoring Cost Scenarios for VKA (Consultations and PT Testing) During the First Three Months (Three and Six Months of Total Treatment Duration).

Table 6

CADTH Common Drug Review Analysis for Anticoagulation Clinic Versus GP Clinic Distribution Scenarios for VKA Monitoring (Three and Six months of Total Treatment Duration).

When the number of consultations and PT testing for VKA is reduced, cost savings are still realized for three-month treatment with rivaroxaban. For six months of treatment, during which patients require only five consultations and PT tests, no further cost savings are observed for rivaroxaban.

Using data from a Canadian costing study,² the manufacturer estimated the cost per consultation and PT test to be $15.95 for an anticoagulation clinic (5% of patients) and $46.52 for GP or community setting (95% of patients); the percentage of patients for each clinic was estimated by the manufacturer based on published literature.¹ When varying the proportion of patients tested in the two settings, rivaroxaban remains cost saving when used for three months; however, when 50% of patients are tested in clinic and 50% by GPs, no further cost savings are observed for rivaroxaban.