Humanistic and economic aspects of haemophilia treatment in Bulgaria. Comparison between two therapeutic approaches: prophylactic vs. on-demand treatment

Figures & data

Table 1. Input model parameters.

Parameter	Prophylactic regimen	‘On demand’ regimen
Number of patients (data from NHIF)	254	254
Dose regimen	20 IU/kg/3 times weekly	40 IU/kg/on demand (30 IU to 40 IU)
Number of haemorrhages yearly		20.91 (17–20.91)
Number of hospitalizations yearly	5 (1–6)	20.91 (17–33.2)
Number of days of inability to work	1 (1–3)	19 (9–19)
Yearly probability for surgical intervention	0.0008	0.0023
QALY	0.88 (0.88–0.92)	0.72 (0.68–0.74)
Cost of IU factor VIII (BGN)	0.60	0.60
Cost of surgery when bleeding (BGN)	700	700
Cost of hospitalization when bleeding (BGN)	570	570
Cost of extra factor VІІІ 5000 UI per surgery	0.60	0.60
Average daily wage (BGN)	34	34

Figure 1. Number of patients with severe haemophilia in age groups.

Figure 2. Necessary UI blood factor VIII in both therapeutic regimes.

Figure 3. Total cost for prophylactic therapeutic regime.

Figure 4. Total cost for on-demand therapeutic regime.

Table 2. Total costs (BGN) in the base case model where all patients are either on prophylactic or on-demand regime.

	Variables in base case dosage regime	Costs	Difference
Costs for factor VIII	Prophylaxis	27,878,572.80	20,404,971
	On demand	7,473,602.02
Costs for surgical interventions	Prophylaxis	751.84	−1410
	On demand	2161.54
Costs for hospitalization	Prophylaxis	1,612,900	−5,132,248
	On demand	6,745,147.8
Indirect costs	Prophylaxis	8636	−155,448
	On demand	164,084

Table 3. Total costs in the base case model where all patients are either on prophylactic or on demand regime.

	Variables in the current therapeutic practice	Costs	Difference
Costs for factor VIII	Prophylaxis	27,878,573	17,443,050
	Prophylaxis at the age of 18 then on-demand	10,435,523
Costs for surgical interventions	Prophylaxis	752	−976.80
	Prophylaxis at the age of 18 then on-demand	1729
Costs for hospitalization	Prophylaxis	1,612,900	−3,556,203
	Prophylaxis at the age of 18 then on-demand	5,169,103
Indirect costs	Prophylaxis	8636	−107,712
	Prophylaxis at the age of 18 then on-demand	116,348

Figure 5. The necessary IU of factor VIII for prophylactic dosage regime in different age groups.

Figure 6. Cost of factor VIII for prophylactic dosage regime in different age groups.

Table 4. Change in costs with increase of age when patients change to ‘on demand’ treatment.

	Cost factor VIII	Cost major surgery	Cost of hospitalization	Indirect cost
Switch 18	10,435,523	1728.64	5,169,103	116,348
Switch 25	12,615,904	1606.54	4,724,578	102,884
Switch 30	14,300,744	1512.19	4,381,081	92,480
Switch 35	16,679,342	1378.99	3,896,144	77,792
Switch 40	19,751,697	1206.94	3,269,767	58,820

Table 5. Incremental cost–utility ratio.

	Total cost	Incremental cost	Total QALY	Incremental QALYs	Incremental cost–utility ratio (ICUR)
All on demand	11,959,712		183		65,354
Switch at 18	15,722,703	3,762,991	196	13	289,461
Switch at 25	17,444,973	1,722,270	199	3	574,090
Switch at 30	18,775,817	1,330,844	202	3	443,615
Switch at 35	20,654,657	1,878,840	205	3	626,280
Switch at 40	23,081,491	2,426,834	210	5	485,367
All on prophylactic	44,976,098	21,894,607	224	12	1,824,551

Figure 7. Tornado diagram for sensitivity analysis.