1. Andre Lamy on behalf of the COMPASS Investigators
Cost Impact of Rivaroxaban Plus Aspirin versus Aspirin in the COMPASS Trial
Andre Lamy on behalf of
the COMPASS Investigators

2. Disclosures The COMPASS trial was funded by grant from Bayer AG
The authors had free access to the complete study data and performed all of the analyses independently
Other conflicts of interest were reported in the main manuscript (NEJM)

3. COMPASS Key objectives
To determine in stable CAD or PAD whether:
Rivaroxaban 2.5mg bid + aspirin 100mg od, or
Rivaroxaban 5mg bid
reduces the risk of CV death, stroke or MI compared with aspirin 100 mg od

4. 2,200 participants with a primary outcome event
Design
Stable CAD or PAD
2,200 participants with a primary outcome event
Rivaroxaban 2.5 mg bid
+ Aspirin 100 mg od
Rivaroxaban 5 mg bid R
Run-in
(Aspirin)
Aspirin 100 mg od
Expected mean follow up: 3-4 years

5. Primary Outcome CV death, stroke, MI
R + A N=9,152
Riva
N=9,117
Aspirin
N=9,126
Riva + aspirin
vs. aspirin
Rivaroxaban N
(%) HR
(95% CI) p
CV death, stroke, MI
379
(4.1)
448
(4.9)
496
(5.4)
0.76
( )
<0.0001
0.90
( )
0.12
(MI)
NEJM 2017;377:

6. Economic Analysis Design
Only Riva 2.5 mg BID + ASA 100 mg OD (n=9152) vs. ASA 100 mg OD (n=9126)
In-trial analysis of cost impact
Cost-effectiveness model is in development (QALYs)
All costs converted to US dollars ($USD)
No discounting (mean follow-up of 23 months)

7. Economic Analysis Design
All CV events included (non-CV excluded)
Costs are direct medical costs consumed in hospital
Events and procedures (DRG approach)
Stroke, dialysis and limb amputations incur costs beyond the event itself (1 year perspective)
Unit costs from the following countries:
US, Canada, France, Germany
Events and resources from all patients are applied to each country using their specific unit costs

8. Events: Difference in costs (1)
Riva 2.5 mg BID + ASA 100 mg OD
(n=9152)
N Events
ASA 100 mg OD
(n=9126)
Diff.
Costs $
USD
Stroke (all) 97
172
-75
-3,664,425
Myocardial Infarction
229
269
-40
-337,667
Severe Limb Ischemia 60
113
-53
-364,163
Resuscitated Cardiac Arrest 56 73
-17
-15,626
Venous Thromboembolism 23 45
-22
-153,824
Angina
526
575
-49
-184,725

9. Events: Difference in costs (2)
Riva 2.5 mg BID + ASA 100 mg OD
N Events
Aspirin 100 mg OD
Diff.
Costs $
USD
Heart Failure
280
265 15
115,803
Cardiac Arrhythmia
292
264 28
146,485
Syncope
101 86
72,525
TIA 51 42 9
37,907
Bleeding – ER Visit
108 72 36
9,108
Bleeding – Hosp. 32 11 21
158,277
Total event costs
-4,180,325

10. Procedures: Difference in costs
Riva 2.5 mg BID + ASA 100 mg OD
Aspirin 100 mg OD
Diff.
Costs
$ USD
Vascular Surgery 72
109
-37
-319,203
Peripheral Angioplasty
143
186
-43
-804,117
Limb Amputation 41 67
-26
-558,179
PCI
446
491
-45
-703,000
Coronary Angiography
397
400 -3
-14,420
CABG 75 8
297,914
Carotid Angioplasty 14 12 2
27,565
Pacemaker/ICD 92 86 6
109,456
Total procedures costs
-1,963,984
TOTAL (events and procedures)
-6,144,309

11. Results: Mean event and procedure cost
Mean cost per participant
Riva 2.5 mg BID + ASA 100 mg OD
(n=9152)
ASA 100 mg OD
(n=9126)
Difference $
USD
Events
1528
(13,982,655)
1990
(18,162,890)
-462
(4,180,325)
Procedures
1936
(17,715,544)
2156
(19,679,529)
-220
(1,963,984)
TOTAL
(overall)
3964
(31,698,199)
4646
(37,842,419)
-682
(6,144,309)

12. Results: Mean costs per country Mean cost per participant
(R+A vs. A)
Events
Procedures
Total Difference
$USD
United States
-462
-220
-682
Canada
-516
-155
-671
France
-379
-165
-543
Germany
-396
-152
-548

13. Mean cost per participant
Subgroup: CAD and PAD
Mean cost per participant
(R+A vs. A) N
Events
Procedures
Total Difference
$USD
CAD only
13277
-382 22
-360
PAD only
1699
-205
-1065
-1270
CAD + PAD
3297
-922
-741
-1663
2 or more vascular beds
4158
-1069
-615
-1684

14. Only direct health care costs Indirect costs for R+A presumably lower
Limitations
Only direct health care costs
Indirect costs for R+A presumably lower
Only events, procedures costs
Rivaroxaban 2.5mg BID plus aspirin
Not yet approved for this indication
List price for Rivaroxaban 2.5 mg BID is still unknown for this indication

15. Rivaroxaban 2.5 mg BID + ASA 100 mg OD:
Conclusions
Rivaroxaban 2.5 mg BID + ASA 100 mg OD:
Clinically better than ASA 100 mg OD
Decreases direct costs of hospitalization, procedures, and major cardiovascular events
Similar results in US, Canada, France and Germany