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

Summary

To estimate the costs and consequences of using recombinant activated Factor VII (rFVIIa; NovoSeven (Novo Nordisk)), compared with activated prothrombin-complex concentrate (aPCC; FEIBA (Baxter Healthcare)), to manage a minor (i.e. mild to moderate) bleeding episode at a haemophilia treatment centre (Comprehensive Care Centre; (CCC)) in the UK among adults with high titre, high responding inhibitors (>10 BU).

This was a modelling study performed from the perspective of the UK's National Health Service (NHS).

Clinical outcomes and resource utilisation attributable to managing a minor bleed were obtained from published literature, supplemented with information about treatment patterns and associated resource utilisation derived from interviews with 22 consultant haematologists experienced in managing inhibitor patients. Using these data sources, a decision tree modelling the management of a minor bleed at a CCC was constructed. Unit resource costs at 1999/2000 prices were applied to the resource utilisation estimates in the model to calculate the expected NHS cost of managing a minor bleeding episode. Consensus on the probabilities and resource utilisation estimates in the model were reached at a meeting comprising seven of the 22 consultant haematologists.

The expected NHS cost of managing a minor bleeding episode among adults initially treated with rFVIIa or aPCC was estimated to be £11,794 and £20,467, respectively. Additionally, the expected time to resolving a minor bleeding episode when initially treated with rFVIIa or aPCC was estimated to be 30 hours and 58 hours, respectively.

Our model suggests that rFVIIa is a cost effective treatment compared to aPCC for the treatment of a minor bleed at a CCC, since it improves clinical outcome and reduces NHS costs. This finding warrants further investigation in a prospective, comparative, randomised controlled study.

Key words: :

• activated prothrombin-complex
• costs
• Factor VII
• economics
• haemophilia