The COMPASS trial evaluated the clinical efficacy of adding rivaroxaban 2.5 mg twice daily to aspirin 100 mg once daily compared with aspirin alone in patients with coronary artery disease and peripheral artery disease. While the combination showed superior clinical outcomes in the trial, the present analysis sought to project the cost-effectiveness of that regimen specifically from a Scandinavian perspective over a lifetime horizon. The primary objective reported was to determine mean lifetime costs (expressed in USD) and quality-adjusted life-years (QALYs) for the rivaroxaban-plus-aspirin strategy versus aspirin alone.
A two-state Markov model was used to estimate mean lifetime costs and QALYs. The model structure categorized patients into health states appropriate for a lifetime projection; the source reports a 2-state model without further granularity in the abstract. Mortality inputs for the lifetime projection were taken from US mortality data. Costs were calculated and reported in US dollars, with regional currency conversions presented for Scandinavian countries.
The analysis included both subgroup analyses and sensitivity analyses to examine robustness and variability in the projected outcomes. The abstract indicates these analyses were performed but does not provide detailed subgroup definitions, model parameter values, utilities, event rates, or specific sensitivity scenarios in the available text.
Using the two-state Markov approach and the specified inputs, the lifetime projection found that adding rivaroxaban 2.5 mg twice daily to aspirin 100 mg daily led to lower mean lifetime costs compared with aspirin alone. The reported cost difference was -$3,791 USD. The authors also provided equivalent cost differences in Scandinavian currencies: -23,675 DKK, -27,410 NOK, and -29,200 SEK.
In addition to cost savings, the rivaroxaban-plus-aspirin regimen produced an incremental gain of 1.17 QALYs versus aspirin alone over the modeled lifetime. This combination of lower costs and greater QALYs indicates that the rivaroxaban-plus-aspirin strategy dominated aspirin alone in the modeled Scandinavian setting.
The abstract states that subgroup and sensitivity analyses were performed to test the robustness of the cost-effectiveness projection. No further numerical results or subgroup-specific findings are reported in the abstract text provided. Details such as which subgroups were analyzed, how sensitive the results were to changes in key parameters (for example, drug costs, event rates, or utility weights), or whether any scenarios reversed the dominance result are not reported in the available source excerpt.
From the Scandinavian perspective modeled in this analysis, the addition of rivaroxaban 2.5 mg twice daily to aspirin 100 mg daily in participants similar to those enrolled in COMPASS was projected to be a dominant strategy compared with aspirin alone. The model estimated both cost savings (−$3,791 USD; with corresponding regional currency figures) and a clinically meaningful improvement in lifetime health as measured by a gain of 1.17 QALYs. Based on the information provided, the combination therapy therefore offers improvements in health outcomes while reducing projected lifetime costs in this modeled scenario.
It should be noted that the abstract provides only a summary of methods and outcomes. Specific model inputs (beyond the use of a 2-state Markov model and US mortality data), detailed subgroup definitions, and full sensitivity analysis results were not reported in the abstract text available here. For full transparency on assumptions, event rates, utility weights, drug cost inputs, and the range of sensitivity scenarios, readers should consult the full text of the article.
The article lists the following key terms and indexed MeSH concepts relevant to the analysis: Rivaroxaban; anticoagulation; coronary artery disease; peripheral artery disease; aspirin; cost-effectiveness; cost savings; cost–benefit analysis; cost-effectiveness analysis; drug administration schedule; drug costs; cardiovascular diseases; mortality; prevention and control.