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COMPASS: Rivaroxaban plus aspirin reduces direct costs for stable atherosclerotic disease
ANAHEIM, Calif. — Among patients with stable atherosclerotic vascular disease, a regimen of rivaroxaban 2.5 mg twice daily plus aspirin 100 mg daily reduced direct costs of hospitalization, procedures and other major CV events compared with aspirin alone, according to a new analysis from the COMPASS trial.
However, the analysis did not include drug treatment costs, survival metrics and quality-of-life metrics, a discussant said at the American Heart Association Scientific Sessions.
As Cardiology Today previously reported, in the main results of the COMPASS trial of 27,395 patients with stable atherosclerotic vascular disease, patients assigned 2.5 mg rivaroxaban (Xarelto, Janssen Pharmaceuticals/Bayer AG) twice daily plus 100 mg aspirin once daily had fewer occurrences of the primary outcome of stroke, CV death or MI compared with those assigned aspirin alone at 2 years.
For the new analysis, Andre Lamy, MD, MHSc, FRCS(C), professor of surgery at McMaster University in Hamilton, Ontario, Canada, and associate member in the department of clinical epidemiology and biostatistics at McMaster, and colleagues evaluated the effect of rivaroxaban plus aspirin vs. aspirin alone on direct medical costs consumed from CV events and procedures, including costs up to 1 year as a result of stroke, dialysis or limb amputations, in patients from the COMPASS trial population. Unit costs were calculated for the United States, Canada, France and Germany.
Compared with aspirin alone, rivaroxaban plus aspirin saved $4,180,325 in total event costs and $1,963,984 in total procedure costs, for a total direct costs savings of $6,144,309, Lamy said during a presentation. He said the biggest impact came from stroke, which represented a savings of $3,664,425 for rivaroxaban plus aspirin.
Mean event plus procedure costs were $682 less per patient among those assigned rivaroxaban plus aspirin vs. those assigned aspirin alone, he said.
This represented a savings of $682 per patient in the United States, $671 per patient in Canada, $543 in France and $548 in Germany, he said.
The greatest savings occurred in patients with peripheral artery disease but not CAD ($1,270 per patient), patients with CAD and PAD ($1,663 per patient) and patients with disease in two or more vascular beds ($1,684 per patient), according to the researchers.
Rivaroxaban 2.5 mg is not yet approved for this indication, so the list price for it is not yet known, Lamy said.
“Rivaroxaban 2.5 mg [twice daily] plus aspirin 100 mg per day is clinically better than aspirin once a day and reduces direct costs of hospitalization, procedures and major cardiovascular events,” Lamy said.
In a discussant presentation, David J. Cohen, MD, MSc, interventional cardiologist at Beth Israel Deaconess Medical Center and Cardiology Today’s Intervention Editorial Board Member, said there was a “modest cost offset” for the overall study population.
“Cost offsets were driven mainly by stroke benefit, which represented more than 50% of the total,” he said. “Additional cost offsets were largely derived from decreased coronary and peripheral revascularization procedures. The cost offsets were enhanced in patients with PAD and involvement of multiple vascular beds.”
However, he said, limitations include that most patients with CAD or PAD live longer than the 2 years represented in the study, that budget impact cannot be assessed because drug costs are not available, and “the study only considers one of the three key components of an economic analysis: It is missing drug-treatment costs and health benefits such as improved survival and improved quality of life.”
If rivaroxaban 2.5 mg were priced at 50% of the cost of rivaroxaban 10 mg, for U.S. patients, it would add $2,043 per year to net annual costs for the overall cohort, which drops to $1,519 per year in net annual costs for those with disease in at least two vascular beds, but would add fewer net annual costs for Canadian patients, and may be cost-saving for Canadian patients with disease in at least two vascular beds, Cohen said.
“The ultimate value of this therapy will depend on drug cost as well as the durability of benefit beyond the 2-year trial observation period,” he concluded. – by Erik Swain
Reference:
Lamy A, et al. LBS.05. New insights into the risks, benefits, and costs of antithrombotic therapy. Presented at: American Heart Association Scientific Sessions; Nov. 11-15, 2017; Anaheim, Calif.
Disclosure: The COMPASS trial was funded by a grant from Bayer AG. Lamy reports no relevant financial disclosures. Cohen reports he serves as a consultant or advisory board member for AstraZeneca, receives honoraria from AstraZeneca and receives research grants from AstraZeneca, Daiichi Sankyo, Eli Lilly and Merck.
Perspective
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This analysis is of interest because one of the first things many clinicians thought about when the main results of COMPASS came out was the cost impact of the medications. This is the first analysis of the cost impact. It tells us that with the number of strokes and MIs prevented, the cost impact of those hospitalizations and procedures may be significant. What we will need now is to see if there is an indication created for low-dose rivaroxaban, and the cost of the medication to patients. When those happen, we can perform the proper long-term cost analyses in these patients to find out whether the combination of the two drugs will be effective long term in terms of cost of life-years saved, total hospitalizations, procedures and other factors. That would give us a final word on the true cost savings and economic impact.
This analysis could make us more enthusiastic about the initial results of COMPASS because we know that the costs of prevention appear extensive, even if we don’t yet know the cost of the drug. This is an encouraging study because of how well the researchers did their homework in showing the potential cost savings in hospitalizations and procedures.