A cost evaluation of treatment alternatives in mild-to-moderate bleeding episodes in haemophilia patients with inhibitors in Turkey

Summary A decision-analysis model was constructed to assess total direct health care costs of four current first-line treatment options for mild-to-moderate bleeding episodes in haemophilia patients with inhibitors in Turkey: recombinant activated Factor VII (rFVIIa); high-dose Factor VIII; prothrombin complex concentrate (PCC); and activated PCC (aPCC). Resource utilisation was based on a retrospective analysis of 105 bleeding episodes treated during the period January 1996 to December 2002. Clinical outcomes were derived from a combination of the retrospective patient data and literature review, both validated by an expert panel of Turkish haematologists. rFVIIa was more effective and resolved bleeds more quickly than any of the alternatives. rFVIIa and PCC were associated with similar direct treatment costs that were relatively lower than those compared with the other options. Given the better efficacy, rFVIIa should be considered the preferred treatment option in the management of haemophilia patients with inhibitors in Turkey.

[1]  J. Journeycake,et al.  Coagulation disorders. , 2003, Pediatrics in review.

[2]  J. Guest,et al.  Modelling the economic impact of recombinant activated Factor VII and activated prothrombin-complex concentrate in the treatment of a mild to moderate bleed in adults with inhibitors to clotting Factors VIII and IX at a comprehensive care centre in the UK , 2002 .

[3]  F. Blei,et al.  Human coagulation factor FVIIa (recombinant) in the management of limb-threatening bleeds unresponsive to alternative therapies: results from the NovoSeven emergency-use programme in patients with severe haemophilia or with acquired inhibitors. , 2000, Blood coagulation & fibrinolysis : an international journal in haemostasis and thrombosis.

[4]  L. Aledort.  Economic aspects of haemophilia care , 1999, Haemophilia : the official journal of the World Federation of Hemophilia.

[5]  I. Scharrer,et al.  Recombinant factor VIIa for patients with inhibitors to factor VIII or IX or factor VII deficiency , 1999, Haemophilia : the official journal of the World Federation of Hemophilia.

[6]  J. Gill,et al.  Home Treatment of Mild to Moderate Bleeding Episodes Using Recombinant Factor VIIa (Novoseven) in Haemophiliacs with Inhibitors , 1998, Thrombosis and Haemostasis.

[7]  J. Goudemand.  Le facteur VII activé recombinant: un nouveau traitement de l'hémophilie , 1998 .

[8]  J. Dixon.  Other national models , 1998 .

[9]  J. Goudemand.  [Recombinant activated factor VII: a new treatment for hemophilia]. , 1998, Transfusion clinique et biologique : journal de la Societe francaise de transfusion sanguine.

[10]  C. Rothschild,et al.  Multicenter Retrospective Study on the Utilization of FEIBA in France in Patients with Factor VIII and Factor IX Inhibitors , 1997, Thrombosis and Haemostasis.

[11]  T. Nowak,et al.  Surgery in Hemophilia A Patients with Factor VIII Inhibitor: 10-Year Experience , 1996, World Journal of Surgery.

[12]  M. Hilgartner,et al.  Frequency of inhibitor development in haemophiliacs treated with low-purity factor VIII , 1993, The Lancet.

[13]  R. Bick.  Hematology : clinical and laboratory practice , 1993 .

[14]  Joseph T. DiPiro,et al.  Pharmacotherapy: A pathophysiologic approach , 1992 .

[15]  M. Hilgartner,et al.  Efficacy and safety of vapor‐heated anti‐inhibitor coagulant complex in hemophilia patients. FEIBA Study Group , 1990, Transfusion.

[16]  C. Rizza.  The management of haemophiliacs who have antibodies to factor VIII. , 2009, Scandinavian journal of haematology. Supplementum.

[17]  Lusher Jm.  Controlled clinical trials with prothrombin complex concentrates. , 1984 .

[18]  J. Lusher.  Controlled clinical trials with prothrombin complex concentrates. , 1984, Progress in clinical and biological research.

[19]  S. Shapiro,et al.  Efficacy of prothrombin-complex concentrates in hemophiliacs with antibodies to factor VIII: a multicenter therapeutic trial. , 1980, The New England journal of medicine.

[20]  G. Buchanan,et al.  Use of prothrombin complex concentrates in hemophiliacs with inhibitors: clinical and laboratory studies. , 1978, Pediatrics.