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Cost and outcome: comparisons of two alternative bypassing agents for persons with haemophilia A complicated by an inhibitor.

Steen Carlsson, Katarina LU ; Astermark, Jan LU ; Donfield, Sharyne and Berntorp, Erik LU (2008) In Thrombosis and Haemostasis 99(6). p.1060-1067
Abstract
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... (More)
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. (Less)
Please use this url to cite or link to this publication:
author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Thrombosis and Haemostasis
volume
99
issue
6
pages
1060 - 1067
publisher
F K Schattauer Verlag Gmbh
external identifiers
  • WOS:000256829900016
  • PMID:18521509
  • Scopus:44949107207
ISSN
0340-6245
DOI
10.1160/TH07-11-0698
language
English
LU publication?
yes
id
71412c9a-5728-40c5-8cf9-00173eb0e05d (old id 1169211)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/18521509?dopt=Abstract
date added to LUP
2008-07-03 09:14:27
date last changed
2016-10-13 04:24:45
@misc{71412c9a-5728-40c5-8cf9-00173eb0e05d,
  abstract     = {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.},
  author       = {Steen Carlsson, Katarina and Astermark, Jan and Donfield, Sharyne and Berntorp, Erik},
  issn         = {0340-6245},
  language     = {eng},
  number       = {6},
  pages        = {1060--1067},
  publisher    = {ARRAY(0xbca8ea8)},
  series       = {Thrombosis and Haemostasis},
  title        = {Cost and outcome: comparisons of two alternative bypassing agents for persons with haemophilia A complicated by an inhibitor.},
  url          = {http://dx.doi.org/10.1160/TH07-11-0698},
  volume       = {99},
  year         = {2008},
}