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Rivaroxaban (Xarelto): Treatment of Venous Thromboembolic Events (Deep Vein Thrombosis [DVT], Pulmonary Embolism [PE]) and Prevention of Recurrent DVT and PE [Internet]. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2015 Aug.

Cover of Rivaroxaban (Xarelto)

Rivaroxaban (Xarelto): Treatment of Venous Thromboembolic Events (Deep Vein Thrombosis [DVT], Pulmonary Embolism [PE]) and Prevention of Recurrent DVT and PE [Internet].

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4ISSUES FOR CONSIDERATION

Price Analysis

From the CDR analysis for price reduction scenarios in Table 4 in Appendix 1, the price of rivaroxaban would need to be reduced by 20% to remain cost saving at 12 months. Greater price reductions of rivaroxaban would be required for cost savings or equal costs using longer treatment time frames.

Patients on Treatment Over Six Months

The CDR clinical expert estimated around 30% to 50% of patients would continue treatment beyond six months. Because of the nature of the model, CDR cannot determine the exact duration of treatment beyond which rivaroxaban becomes more costly than LMWH plus VKA). Cost savings of rivaroxaban will be attenuated (and greater costs may occur) as the proportion of patients on treatment beyond six months increases, and as the total duration of treatment in these patients increases (i.e., 12, 24, or 36 months). Further, switching from rivaroxaban to warfarin is likely to be difficult for both patients and health care practitioners. Operationalization of starting rivaroxaban only in patients in whom short-term treatment is indicated would necessitate accurate determination of duration of therapy at initiation of therapy.

Irreversibility of Rivaroxaban

There are no reversal drugs available for rivaroxaban if bleeding occurs. It is also unsuitable for patients with a high risk of bleeding or poor kidney function.

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Bookshelf ID: NBK344323
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