Rivaroxaban for the treatment of deep vein thrombosis and ...

The manufacturer did not assume a reduction in QoL for patients experiencing a minor bleed event.
Health state utility values and the duration used in the economic model are summarised in Table 29.
Table 29: Health state utility values used in the cost-effectiveness evaluation
(Adaptation from Table 46, p. 134, MS, 1 November 2011)
Model state Point
estimate
Adjustments to
utility norm due to
modelled events
111
Source Duration
Population norm 0.825 NA Kind 1998 66 NA
Post IC bleed 0.71 NA Rivero-Arias 2010 67 Chronic
CTEPH 0.56 NA Meads 2008 70 Chronic
DVT 0.729 0.884 d Derived from Locadia
et al. (2004) 68 and
Kind et al.(1998) 66
1 month
PE 0.547 0.663 1 month
EC bleed 0.287 0.684 1 month
IC bleed 0.564 0.347 3 months
PTS 0.767 0.930 Derived from Lenert
et al.(1997) 69 and
Kind et al.(1998) 66
Chronic
The utility decrements for patients experiencing a DVT, PE or a major EC bleed event was assumed
to last a month in line with the assumption used in NICE CG92. 18 The utility decrement for patients
with an IC bleed event was assumed to last three months. Other events were assumed to be chronic.
Finally, health state utility values were assumed to be constant over time, i.e. no variation by age.
The ERG is generally satisfied with the assumptions made by the manufacturer to value the different
health states. A systematic review of the literature was conducted to identify potential sources of
evidence and this appears to be of reasonable quality; however, the ERG did not replicate the
systematic review due to time and resource constraints. The manufacturer assumed that the utilities
for the IC and EC bleed health states were identical to GI bleeds and haemorrhagic stroke
respectively. The manufacturer also used data from different studies that used different methods to
value the different health states. Whilst this is not very robust, the ERG acknowledges that all the
evidence was not available from one study, conforming to the NICE reference case (using EQ-5D and
time trade off estimated from the general population).
d Locadia quoted a population norm (own health) as 0.95 (95% CI 0.81-1.00) and therefore further adjustment was applied to
the values reported in the study, multiplying by 0.825/0.95
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