Economic analysis of recombinant activated factor VII versus plasma-derived activated prothrombin complex concentrate in mild to moderate bleeds: Haemophilia registry data from the Czech Republic

• Authors: SALAJ Peter; PENKA Miroslav; SMEJKAL Petr; GEIEROVA Vera; OVESNÁ Petra; BRABEC Petr; CETKOVSKÝ Petr; KUBES Radovan; MESTERTON Johan; LINDGREN Peter
• Year of publication: 2012
• Type: Article in Periodical
• Magazine / Source: Thrombosis Research
• MU Faculty or unit: Faculty of Medicine
• Doi: http://dx.doi.org/10.1016/j.thromres.2012.02.005
• Field: Cardiovascular diseases incl. cardiosurgery
• Keywords: Cost-effectiveness; Haemophilia; Plasma-derived activated prothrombin complex concentrate; Recombinant factor VIIa; Registry
• Description: Several studies suggest that recombinant activated factor VII (rFVIIa) is more cost-effective than plasma-derived activated prothrombin complex concentrate (pd-aPCC) in haemophilia with inhibitors. However, most do not consider differences between treated patients. This study compared the pharmacoeconomics of rFVIIa versus pd-aPCC treatment of mild to moderate bleeds in inhibitor patients, taking co-variables into account. Methods The HemoRec and HemIS registries capture exhaustive bleeding data in inhibitor patients in the Czech Republic. For each bleed, patient and bleed characteristics, treatment outcomes and bypassing agent use were retrospectively analysed, and direct costs of care per bleed calculated. Generalised Linear Model regression methods with cluster effect were employed to account for the possibility of several bleedings from the same patient. Results There were 108 and 53 mild to moderate bleeds in the rFVIIa and pd-aPCC groups, respectively. Although re-bleeding rates were similar in both groups, deeper analyses revealed significant differences in time to bleed resolution: 93.8% of bleeds treated with rFVIIa were resolved within less than 12h, versus 60.4% with pd-aPCC (P<0.001). Mean total cost/bleed was lower with rFVIIa (336,852 [median, 290,696] CZK; eur12,760 [11,011]) than pd-aPCC (522,768 [341,310] CZK; eur19,802 [12,928]) (P=0.002). Results were maintained after controlling for potential co-variables (bleed nature, time to treatment, target joints). Conclusions The lower total treatment costs per bleed with rFVIIa than pd-aPCC suggest that first-line rFVIIa is more cost-effective than pd-aPCC in mild to moderate bleeds. Time to bleed resolution was also significantly shorter with rFVIIa. These results were maintained when controlled for potential confounders.