Cost-effectiveness of rivaroxaban compared with enoxaparin plus a vitamin K antagonist for the treatment of venous thromboembolism

Background:

Venous thromboembolism (VTE), comprised of deep vein thrombosis (DVT) and pulmonary embolism (PE), is commonly treated with a low-molecular-weight heparin such as enoxaparin plus a vitamin K antagonist (VKA) to prevent recurrence. Administration of enoxaparin?+?VKA is hampered by complexities of laboratory monitoring and frequent dose adjustments. Rivaroxaban, an orally administered anticoagulant, has been compared with enoxaparin?+?VKA in the EINSTEIN trials. The objective was to evaluate the cost-effectiveness of rivaroxaban compared with enoxaparin?+?VKA as anticoagulation treatment for acute, symptomatic, objectively-confirmed DVT or PE.

Methods:

A Markov model was built to evaluate the costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios associated with rivaroxaban compared to enoxaparin?+?VKA in adult patients treated for acute DVT or PE. All patients entered the model in the ‘on-treatment’ state upon commencement of oral rivaroxaban or enoxaparin?+?VKA for 3, 6, or 12 months. Transition probabilities were obtained from the EINSTEIN trials during treatment and published literature after treatment. A 3-month cycle length, US payer perspective ($2012), 5-year time horizon and a 3% annual discount rate were used.

Results:

Treatment with rivaroxaban cost $2,448 per-patient less and was associated with 0.0058 more QALYs compared with enoxaparin?+?VKA, making it a dominant economic strategy. Upon one-way sensitivity analysis, the model’s results were sensitive to the reduction in index VTE hospitalization length-of-stay associated with rivaroxaban compared with enoxaparin?+?VKA. At a willingness-to-pay threshold of $50,000/QALY, probabilistic sensitivity analysis showed rivaroxaban to be cost-effective compared with enoxaparin?+?VKA approximately 76% of the time.

Limitations:

The model did not account for the benefits associated with an oral and minimally invasive administration of rivaroxaban. ‘Real-world’ applicability is limited because data from the EINSTEIN trials were used in the model. Also, resource utilization and costs were based on the US healthcare system.

Conclusion:

Rivaroxaban is a cost-effective option for anticoagulation treatment of acute VTE patients.     

基于系统理论的水资源统一管理范畴探讨

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CHANGE for a New Economic Structure？

Opportunity in the financial crisis？
For a long time, China＇s fast economic growth is heavily dependent on growth of exports, particularly dependent on exports of low value-added, low technological products. Although the policy-makers and scholars are aware of the importance and necessity of industrial structure improvements since 1992, it is hard to have a real incentive to promote economic restructuring under rapid economic growth.     

试论企业劳动者权益保护的若干问题

本文就企业劳动者权益保护的若干问题进行研究探讨.     

出口导向型企业在目前经济形势下的调整

改革开放以来,出口导向型发展模式大大地推动了出口贸易的迅速发展,加快了产业结构调整与升级,提升了我国的国际地位和影响力,促进了国民经济持续稳定增长。但是,随着国际经济环境和国内宏观经济的变化,出口导向型发展模式面临着许多风险,我国应改变粗放型出口增长方式,提高劳动生产率和科技水平,提高内需对经济增长的拉动作用,加快科技创新,提高核心竞争力。     

论以体面劳动为目标的劳动者权利保护

本文认为以法律保护劳动者的人格尊严,是实现体面劳动的重要条件.为了在我国实现体面劳动,需要多方的努力,特别是要完善相应的法律体系,建立起保障劳动者权益的法律机制.     

“杂家”杨德才

一手创办紫文管理咨询有限公司的杨德才,从身分上来讲应该算是商人,可是人们却总习惯尊称他为杨博士.因为他不仅是咨询业内的专家,还兼任学术机构的职务,并且长期为各类报纸的财经版撰写专栏,担任政府机构和跨国企业的顾问.     

基于OLS模型下苏州市用工荒问题的实证分析

为了破解用工荒,使苏州市经济实现可持续发展,文章采用实证分析的方法,针对苏州市近年来出现的用工荒问题,通过建立多元线性回归模型,从深层次破解用工荒与产业结构的关系.研究结果发现,解决用工荒应从实行生活成本补贴、加快产业结构转型升级步伐、加大公共文化服务建设的力度等方面着手进行.     

高职院校毕业生档案管理中的问题及对策

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