Cost-effectiveness in Bleeding Control for Acquired Hemophilia A

Introduction

Acquired hemophilia A (AHA) is an autoimmune disease characterized by the presence of autoantibodies against clotting factor VIII, which leads to very serious morbidity and increased mortality. It is primarily a disease of the older population. The standard of care for bleeding patients with AHA and high inhibitor titers is the administration of bypassing agents, such as activated prothrombin complex concentrate (aPCC), recombinant FVIIa, or porcine FVIII.

Analysis Methodology

The various therapeutic modalities have different advantages and limitations. One way to compare them is through cost-effectiveness analysis (CEA). Using a Markov model for patients with high inhibitor titers, changes in health status from the initial bleeding (continuing bleeding, thrombosis, bleeding cessation, or death) were evaluated. The model uses probabilistic data extracted from the literature. Financial costs were calculated according to the actual expenses of the authors' workplace.

Results

The analysis yielded the following findings:

• During the 6-day model period, aPCC represented the least costly treatment, while rFVIIa was the most expensive (difference of 1778 vs. 13,925 USD).
• The results were slightly better for aPCC compared to the two comparative drugs in the assessment of the parameter of obtaining so-called quality-adjusted life days (QALD).

Conclusion

The authors conclude their analysis by stating that for patients with AHA and high inhibitor titers who exhibit bleeding symptoms, aPCC is the most cost-effective treatment option.

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Source: Najafzadeh P., Kim C., Wang D. et al. A cost-effectiveness model for different treatments of bleeding in patients with acquired hemophilia. American Society for Clinical Pathology, ASCP Annual Meeting, Grapevine, 2019 Nov 7−10. Am J Clin Pathol 2019; suppl. 1: S152.