Clinical and economic analysis of different strategies for the treatment of hemophilia A

Abstract

Although hemophilia A is a rare disease, its treatment is costly, and expenses are mainly related to the cost of factor VIII concentrates. Aim. To evaluate the clinical and economic feasibility of rFVIIa (NovoSeven®) for the treatment of patients with hemophilia A compared to the schemes based on the use of APCC (Feiba). Matherials and methods. Clinical and economic analysis was conducted by the “total cost of illness” method using modeling by building a “decision tree”. This study identifies only the direct costs of pharmacotherapy. The cost of a vial of each of the concentrates analyzed meets the declared value as of December 2016. Results. The analytical model of the “decision tree” was designed to calculate the costs for the outpatient treatment of mild and moderate bleedings. Due to higher clinical efficacy the use of rFVIIa as the first-line therapy saves 32 % to 42 % in the treatment of a patient; in the conditions of the modern Ukrainian pharmaceutical market it is from UAH 170,326.4 to UAH 252,990.4 (with an adapted variant of therapy) and UAH 291,743.1 in the basic variant. When using rFVIIa as the first-line therapy the costs for life appeared to be lower by approximately 10 % than when taking APCC. Conclusions. The use of NovoSeven® is more feasible economically and allows both to improve outcomes and to spend financial resources more efficiently to treat these patients.