2 The technology
2.1 Rivaroxaban (Xarelto, Bayer) is indicated for the 'treatment of deep vein thrombosis (DVT), and prevention of recurrent DVT and pulmonary embolism (PE) following an acute DVT in adults'. For the initial treatment of acute deep vein thrombosis, the recommended dosage of rivaroxaban is 15 mg twice daily for the first 21 days followed by 20 mg once daily for continued treatment and prevention of recurrence.
2.2 The duration of treatment recommended in the summary of product characteristics depends on bleeding risk and other clinical criteria: short-term treatment (3 months) is recommended for those with transient risk factors such as recent surgery and trauma, and longer treatment for permanent risk factors or idiopathic (unprovoked) deep vein thrombosis. The summary of product characteristics further states that experience with rivaroxaban in this indication for more than 12 months is limited. A reduced dosage of 15 mg twice daily for 21 days followed by 15 mg once daily should be used in people with moderate (creatinine clearance 30–49 ml/min) or severe (creatinine clearance 15–29 ml/min) renal impairment. For full details of side effects and contraindications, see the summary of product characteristics.
2.3 Rivaroxaban costs £2.10 per 15 mg or 20 mg tablet. The cost of treatment is estimated to be £235.86, £427.61 and £811.13 for 3, 6 and 12 months of treatment respectively. Costs may vary in different settings because of negotiated procurement discounts.