Cost-Effectiveness of Preparations Used to Stop Bleeding in Patients with AHA
Choosing the right preparation to manage acute bleeding in patients with acquired hemophilia A is not always simple. An interesting perspective and recommendations are provided by a model analysis assessing the cost and effectiveness of individual available preparations.
Introduction
Acquired hemophilia A (AHA) has a potentially high risk of morbidity and mortality. The cause of AHA is the formation of an antibody (inhibitor) against coagulation factor VIII (FVIII). Bleeding episodes in AHA can be treated using activated prothrombin complex concentrate (aPCC), recombinant factor VII (rFVIIa), or recombinant porcine factor VIII (rpFVIII). The authors of the cited study evaluated the effectiveness of rpFVIII in relation to the cost of treatment compared to traditional aPCC or rFVIIa.
Simulation Analysis
The analysis utilized a Markov simulation working with bleeding patients with AHA and a high inhibitor titer who are treated for 6 days using aPCC, rFVIIa, or rpFVIII. The following situations were simulated: a) continuous bleeding, b) thrombosis, c) bleeding stop, d) death.
Results
Excluding the cost of initial treatment on day 0, the total subsequent treatment cost with rFVIIa is significantly higher than with aPCC or rpFVIII (US$13,925 vs. 1,778 vs. 6,057). The average gain in the parameter of quality-adjusted life days (QALDs) was lowest for rpFVIII (4.89) compared to rFVIIa (4.9) and aPCC (4.91). Overall, the analysis showed the best cost-effectiveness in treating bleeding in patients with high inhibitor titer with aPCC compared to the two other therapeutic options.
Conclusion
According to this economic model, for patients with AHA and a high inhibitor titer, aPCC is the best treatment alternative in terms of cost-effectiveness in case of bleeding. It should be considered for all patients for whom it is not contraindicated.
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Source:
Kim C. H., Simmons S. C., Wang D. et al. An economic analysis of different treatments for bleeding in patients with acquired haemophilia. Vox Sang 2020 Apr; 115 (3): 192−199, doi: 10.1111/vox.12877.
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