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

5 COST EFFECTIVENESS
5.1 Review of the cost-effectiveness evidence
The manufacturer’s submission included a review of the cost-effectiveness evidence. 1 Four databases
were searched; Medline, Embase, EconLit and NHS EED. The manufacturer used search terms that
covered deep vein thrombosis, treatment and cost-effectiveness.
The searches identified 1,479 publications, of which 15 publications were reviewed at full-text level
and four studies were included and data extracted. Extraction tables are available in the MS in Table
33 (p. 100 – p. 103)
The manufacturer stated that none of the studies identified were directly relevant to the decision
problem. 1 The ERG agrees with this statement based on the studies included in the review, and
therefore, no further description or critique was carried out by the ERG.
5.2 Summary and critique of the manufacturer’s submitted economic evaluation
5.2.1 Economic evaluation
5.2.1.1 Overview of the manufacturer’s economic evaluation
The manufacturer submitted a decision-analytic model constructed in Microsoft Excel software. 1,49
The economic evaluation uses a Markov approach using eleven possible health states, including
venous thromboembolism recurrences, bleeding events and death. A description of the different health
states and transitions between these states is given in section 5.2.1.6 of the ERG report.
The manufacturer presented two analyses. The primary analysis (or main analysis) compared the use
of rivaroxaban against dual therapy with low molecular weight heparins and vitamin K antagonists
(VKA) (termed dual therapy LMWH/VKA hereafter) delivered over three, six or twelve months in
patients with acute DVT. In its original submission to NICE, the manufacturer also presented a cost-
minimisation analysis in a subgroup of cancer patients and compared the use of rivaroxaban with
LMWH only (using dalteparin). 1 Following a request from the ERG during the clarification process,
the manufacturer submitted an exploratory cost-effectiveness analysis in a subgroup of cancer patients
adapting the existing model framework. 17
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