title: 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.
abstract: BACKGROUND
  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 ≤ 12 h, versus 60.4% with pd-aPCC (P < 0.001). Mean total cost/bleed was lower with rFVIIa (336,852 [median, 290,696] CZK; €12,760 [11,011]) than pd-aPCC (522,768 [341,310] CZK; €19,802 [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.
authors.affiliation: Institute of Haematology and Blood Transfusion, Prague, Czech Republic. peter.salaj@uhkt.cz
authors.forename: Peter
authors.initials: P
authors.lastname: Salaj
authors.forename: Miroslav
authors.initials: M
authors.lastname: Penka
authors.forename: Petr
authors.initials: P
authors.lastname: Smejkal
authors.forename: Vera
authors.initials: V
authors.lastname: Geierova
authors.forename: Petra
authors.initials: P
authors.lastname: Ovesná
authors.forename: Petr
authors.initials: P
authors.lastname: Brabec
authors.forename: Petr
authors.initials: P
authors.lastname: Cetkovsky
authors.forename: Radovan
authors.initials: R
authors.lastname: Kubes
authors.forename: Johan
authors.initials: J
authors.lastname: Mesterton
authors.forename: Peter
authors.initials: P
authors.lastname: Lindgren
mesh_terms: D000328:Adult; D001779:Blood Coagulation Factors / Q000191:economics* / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D018153:Czech Republic; D016527:Drug Costs; D015942:Factor VIIa / Q000191:economics* / Q000627:therapeutic use*; D006467:Hemophilia A / Q000188:drug therapy* / Q000191:economics*; D006801:Humans; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D011994:Recombinant Proteins / Q000191:economics / Q000627:therapeutic use; D012042:Registries; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D001779:Blood Coagulation Factors; D011994:Recombinant Proteins; C025667:prothrombin complex concentrates; D015942:Factor VIIa