title: Cost-Effectiveness Analysis of Plasma Versus Recombinant Factor VIIa for Placing Intracranial Pressure Monitors in Pretransplant Patients With Acute Liver Failure.
abstract: Both plasma- and recombinant activated factor VII (rFVIIa)-based algorithms can be used to correct coagulopathy in preliver transplant patients with acute liver failure requiring intracranial pressure monitor (ICPM) placement. A decision model was created to compare the cost-effectiveness of these methods. A 70-kg patient could receive either 1 round of plasma followed by coagulation testing or 2 units of plasma and 40 μg/kg rFVIIa. Intracranial pressure monitor is placed without coagulation testing after rFVIIa administration. In the plasma algorithm, the probability of ICPM placement was estimated based on expected international normalized ratio (INR) after plasma administration. Risks of rFVIIa thrombosis and transfusion reactions were also included. The model was run for patients with INRs ranging from 2 to 6 with concomitant adjustments to model parameters. The model supported the initial use of rFVIIa for ICPM placement as a cost-effective treatment when INR ≥2 (with incremental cost-effectiveness ratio of at most US$7088.02).
authors.affiliation: Department of Pathology and Cell Biology, Columbia University Medical Center and the New York-Presbyterian Hospital, New York, NY, USA Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, USA hpp2103@columbia.edu.
authors.forename: Huy P
authors.initials: HP
authors.lastname: Pham
authors.affiliation: Department of Pathology and Cell Biology, Columbia University Medical Center and the New York-Presbyterian Hospital, New York, NY, USA.
authors.forename: Anthony N
authors.initials: AN
authors.lastname: Sireci
authors.affiliation: Department of Health Policy Management, Columbia University Mailman School of Public Health, New York, NY, USA.
authors.forename: Chong H
authors.initials: CH
authors.lastname: Kim
authors.affiliation: Department of Pathology and Cell Biology, Columbia University Medical Center and the New York-Presbyterian Hospital, New York, NY, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Schwartz
mesh_terms: D000465:Algorithms; D016913:Blood Component Transfusion / Q000191:economics*; D003365:Costs and Cost Analysis; D015942:Factor VIIa / Q000008:administration & dosage / Q000191:economics*; D005260:Female; D006801:Humans; D017114:Liver Failure, Acute / Q000191:economics* / Q000628:therapy; D016031:Liver Transplantation; D008297:Male; D018803:Models, Economic; D010949:Plasma; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000191:economics
chemical_list: D011994:Recombinant Proteins; C103587:recombinant FVIIa; D015942:Factor VIIa
keywords: Novoseven; acute liver failure; cost effective; intracranial pressure monitor; plasma transfusion; recombinant activated factor VII