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Enthusiasm for the COMPASS trial's benefit from adding low-dose rivaroxaban (Xarelto) to aspirin in stable atherosclerotic vascular disease should be tempered by the bigger picture, argued Raymond Gibbons, MD.
In this exclusive video, Gibbons, of the Mayo Clinic in Rochester, Minn., who spoke from the meeting where the findings were presented, projected a substantial cost to patients in terms of bleeding risk and to society economically.
"By my analysis, one would have to treat 140 patients for 3 years with rivaroxaban -- 400 patient-years of the drug -- to save one life," he said. "If I estimate the cost of the drug at $3,000 a year, that is more than $1.2 million for one life saved. That's why I think cost-effectiveness analysis needs to be done."
Also, the trial did not disclose optimal medical therapy for secondary prevention, but hinted at less than ideal treatment. "If one wants to improve secondary prevention, there are easier and cheaper ways to do it," Gibbons said, "simply by improving the rate of optimal medical therapy."