Document Detail


Cost and outcome: comparisons of two alternative bypassing agents for persons with haemophilia A complicated by an inhibitor.
MedLine Citation:
PMID:  18521509     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The development of inhibitory antibodies to factor VIII is a serious complication of haemophilia. Two haemostatic agents with different bypassing mechanisms have been used in the treatment of patients with inhibitors: activated prothrombin complex concentrate (aPCC) and recombinant factor VIIa (rFVIIa). The objective was to compare cost and outcome of aPCC and rFVIIa in the treatment of joint bleeds. The analyses were based on the FENOC (FEIBA NovoSeven Comparative Study) crossover study where 48 patients used aPCC and rFVIIa to treat two joint bleeds. Incremental cost-effectiveness ratios were calculated for three outcome measures and the variation in cost was analyzed using two alternative regression methods. Results were subjected to sensitivity analyses. Key determinants of cost were prescribed dose, bodyweight and treatment in addition to protocol. The cost of aPCC was on average lower than rFVIIa. At all but one time point, patients rated slightly higher (but not statistically significantly) percentages of treatment efficacy and stopping of the bleed by aPCC. The reported reduction in pain from start of treatment up to 48 hours varied considerably among individuals. The different relative prices in the US, Turkey and Sweden mattered, but did not reverse the main results. In conclusion, the cost per episode was significantly lower for aPCC. The large individual-level variation in reduction of pain supports decisions that consider the individual patient's experience and that accept trade-offs between cost and reduction in pain rather than focusing on cost only.
Authors:
Katarina Steen Carlsson; Jan Astermark; Sharyne Donfield; Erik Berntorp
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Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Thrombosis and haemostasis     Volume:  99     ISSN:  0340-6245     ISO Abbreviation:  Thromb. Haemost.     Publication Date:  2008 Jun 
Date Detail:
Created Date:  2008-06-03     Completed Date:  2008-08-04     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7608063     Medline TA:  Thromb Haemost     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  1060-7     Citation Subset:  IM    
Affiliation:
Lund University Centre for Health Economics, LUCHE, Lund, Sweden. katarina.steen@luche.lu.se
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Arthralgia / drug therapy,  economics,  etiology
Autoantibodies / blood*
Blood Coagulation Factors / economics*,  therapeutic use
Child
Child, Preschool
Cost-Benefit Analysis
Cross-Over Studies
Drug Costs*
Factor VIII / immunology*
Factor VIIa / economics*,  therapeutic use
Hemarthrosis / drug therapy,  economics*,  etiology
Hemophilia A / complications,  drug therapy,  economics*,  immunology
Hemostatics / economics*,  therapeutic use
Humans
Middle Aged
Pain Measurement
Patient Satisfaction
Recombinant Proteins / economics,  therapeutic use
Sweden
Treatment Outcome
Turkey
United States
Chemical
Reg. No./Substance:
0/Autoantibodies; 0/Blood Coagulation Factors; 0/Hemostatics; 0/Recombinant Proteins; 0/recombinant FVIIa; 37224-63-8/prothrombin complex concentrates; 9001-27-8/Factor VIII; EC 3.4.21.21/Factor VIIa

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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