Cost-utility analysis of immune tolerance induction therapy versus on-demand treatment with recombinant factor VII for hemophilia A with high titer inhibitors in Iran

Figures & data

Table 1 Immune tolerance induction and on-demand default protocols

Protocol	Dose	Success rate (%)	Average patient weight (kg)	QALY
Bonn (high dose)	300 U/kg/day pdFVIII	72.8	60	33.0
Low dose	50 U/kg/day	43.0	60	29.1
Malmö	207 U/kg/day	53.3	60	28.1
On-demand	90–120 rFVIIa μg/kg/day	92	60	25.1

Abbreviations: pdFVIII, plasma-derived factor VIII; QALY, quality-adjusted life-year; rFVIIa, recombinant-activated factor VIIa.

Table 2 Cost of hemostatic agent in Iran (May, 2011)

Factor	Price per unit ($)
Factor VIII	0.3 per IU
Recombinant factor VIIa	684.0 per mg

Table 3 Cost and benefit of the immune tolerance induction (ITI) protocols and on-demand therapy with recombinant factor VIIa

Protocol	Average cost of managing bleeding episodes for 10 years ($)	Quality-adjusted life-years
Bonn ITI	5,528,649.60	33.0
Low-dose ITI	2,243,649.60	29.1
Malmö ITI	4,306,629.60	28.1
On-demand	6,205,248.00	25.1

Table 4 Incremental cost-effectiveness ratios: comparison between all four protocols (cost per quality-adjusted life-year)

Protocol	On-demand	Malmö ITI	Low-dose ITI	Bonn ITI
On-demand
Malmö ITI	Dominates
Low-dose ITI	Dominates	Dominates
Bonn ITI	Dominates	$249,391.84	$842,307.69

Abbreviation: ITI, immune tolerance induction.