Objective  To compare the cost and effectiveness of the new oral anticoagulant rivaroxaban 15 mg or 20 mg once a day for the prevention of thrombosis in patients with nonvalvular atrial fibrillation, and to provide references for clinical rational use of drugs.

Method  The Markov model was used to simulate the survival status of the two dose groups within 30 years, and the cost and health output were calculated separately to obtain the incremental cost-utility ratio (ICUR). Take 3 times of per capita gross domestic product (GDP) in China in 2020 as the willingness-to-pay threshold (WTP) to judge its economy.

Results  During the simulation period, compared with the 15 mg dose group, the 20 mg dose group had cumulative utility improvement of 0.97 quality-adjusted life-year (QALY), had an ICUR of 119 855 Yuan/QALY, had higher GDP and lower WTP, and was economical. Single-factor sensitivity analysis showed that the price and discount rate of the two doses of drugs were the main factors affecting ICUR. The probability sensitivity analysis pointed out that when the WTP was 3 times the per capita GDP, the 20 mg dose was more acceptable (65.2%), and the standard dose of 20 mg had a greater cost-utility advantage.

Conclusion  For patients with nonvalvular atrial fibrillation who take rivaroxaban for a long time to prevent thrombosis, choosing the instructional dose of 20 mg once a day is more cost-effective advantageous than the smaller dose of 15 mg once a day.

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