Cost Minimization Analysis of Activated Prothrombin Complex Concentrate (Apcc) Compared To Recombinant Factor Viia (Rfviia) for Hemophilia Patients With Inhibitors.

REFERENCES [1] Bonnet, P., et al. „Cost minimization analysis to compare activated prothrombin complex concentrate (APCC) and recombinant factor VIIa for haemophilia patients with inhibitors undergoing major orthopaedic surgeries.“ Haemophilia (2009): 1-7. [2] Astermark, J., et al. „A randomized comparison of bypassing agents in hemophilia complicated by an inhibitor: the FEIBA NovoSeven Comparative (FENOC) Study.“ Blood 109 (2007): 546-551. [3] Doležal, T., Adamec, T. „Srovnání nákladové efektivity aPCC (FEIBA) a rFVIIa (NovoSeven) v léčbě krvácivých komplikací u pacientů s hemofilií A a inhibitory v podmínkách České republiky.“ Farmakoekonomika 1 (2011): 14-18, (in Czech) . [4] Putnam, K.G., et al. “A cost minimization model for the treatment of minor bleeding episodes in patients with haemophilia A and high-titre inhibitors.” Haemophilia (2005): 261-269. RESULTS In the scenario of bleeding episodes, the use of APCC instead of rFVIIa brings the potential savings of €4,596-8,704; €5,135-9,347; €5,738-10,807; €4,369-8,527 respectively in Hungary, Slovakia, Slovenia and Serbia (depending on the dosing scheme, see Figure 1). Lower savings are when dosing of 2x90μg/kg of rFVIIa is used, and higher when 1x270μg/kg of rFVIIa is used. While using APCC during major surgeries, the savings are equal to €157,159 (if compared to rFVIIa therapy) and €15,616 (if compared to the combination therapy of APCC and rFVIIa) in Hungary; €180,653 and €16,558 in Slovakia; €196,965 and €19,362 in Slovenia; and €145,979 and €15,422 in Serbia (see Figures 2 and 3). The results of OWSA confirmed the results from the base-case setting. In case of BE with lower dosage of rFVIIa (see Table 1), the savings were well above zero indicating that even with price and dose changes of rFVIIa/APCC there is a certainty of cost-savings. When dosing rFVIIa with 1x270μg/kg per BE, the savings are substantially higher in both lower and higher case compared to situation of lower rFVIIa dosing scheme (Table 2). Finally, OWSA conducted in situation of surgery (Table 3) also confirmed the results from base-case setting. In this surgery situation, the lower case savings were around €100,000 and higher case savings were above €200,000.