A cost-effectiveness analysis of rivaroxaban compared to warfarin for the management of venous thromboembolism in Western Kenya

O’Neill, Emily T., Huang, Andrew W., Wilson-Barthes, Marta, Manji, Imran, Kigen, Gabriel, Busakhala, Naftali, Nyanje, Samuel, Galárraga, Omar and Pastakia, Sonak D. (2025) A cost-effectiveness analysis of rivaroxaban compared to warfarin for the management of venous thromboembolism in Western Kenya. Clinical Drug Investigation, 45 (8). pp. 565-574. ISSN 1173-2563

Text (s40261-025-01454-7) - Published Version Available under License Creative Commons Attribution. Download (979kB)

• Scopus publication

Abstract

Background and Objective: Access to direct oral anticoagulants (DOACs) in sub-Saharan Africa is limited due to prohibitive upfront costs, making warfarin the standard of care for many patients, especially those relying on public-sector healthcare. This study evaluated the cost-effectiveness of using the DOAC, rivaroxaban, compared to warfarin for treating venous thromboembolism (VTE), a cardiovascular disorder caused by blood clots in the veins, in western Kenya. Methods: We developed a discrete-time individual state-transition Markov model to simulate a VTE patient’s quality-adjusted life-years (QALYs) and annual treatment costs under a rivaroxaban or warfarin therapy strategy. Transition state probabilities were derived from real-world event-rate data observed in patients treated with rivaroxaban (n = 160) or warfarin (n = 116) for VTE at Moi Teaching and Referral Hospital in western Kenya. Base-case parameter values were obtained from cohort event rates, local costs, and literature-derived utility values. Cost-effectiveness was assessed over a 1-year time horizon using an incremental cost-effectiveness ratio (ICER) threshold of (US)$6020.40 per QALY gained (equivalent to three times Kenya’s 2021 per capita GDP). Deterministic and probabilistic sensitivity analyses were conducted to assess parameter and model uncertainty. Results: After 12 months, total mean treatment costs per patient were $216.00 and $173.00 using warfarin and rivaroxaban, respectively. In the base-case analysis, rivaroxaban therapy resulted in an additional 0.023 QALYs per patient compared to warfarin, with an ICER of $− 1862.00 per QALY gained. Based on probabilistic sensitivity analysis with Monte Carlo simulation, when costs, utility values, and event rates were varied, rivaroxaban was cost-effective compared to warfarin in 84.1% of all simulations at a willingness-to-pay threshold of $6020.40 per QALY. One-way sensitivity analyses and scenario analyses were stable with rivaroxaban therapy, resulting in fewer costs and higher QALYs. Conclusions: In this study, rivaroxaban is a clinically and economically superior alternative to warfarin. This research may catalyze further discussions with policymakers and industry partners to scale up the appropriate use of rivaroxaban in resource-constrained settings.

Item Type:	Article
Additional Information:	© The Author(s) 2025.
Divisions:	LSE
Subjects:	R Medicine > RM Therapeutics. Pharmacology R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Date Deposited:	28 Aug 2025 13:51
Last Modified:	29 Aug 2025 16:09
URI:	http://eprints.lse.ac.uk/id/eprint/129301

Actions (login required)

View Item