Cost–consequence analysis of long-term prophylaxis in the treatment of von Willebrand disease in the Italian context

Figures & data

Table 1 Direct health care costs

Case report	Drug	Concentrates, IU/year	Cost of long- term prophylaxis treatment per year (A)	Bleeding episodes per year, n	Cost of bleeding episodes per year (B)	Pharmaceutical costs (C = A + B)	Outpatient-monitoring visits per year, n	Cost of outpatient-monitoring visit (D)	Cost of diagnostic and laboratory tests per year (E)	Days of hospitalization per year	Number of hospitalizations per year	Number of hospital admittances (day hospital)	Cost of hospitalization per year (F)	Packed red blood cells per year	Cost of PRBC per year (G)	Health care costs per year without cost of treatment (H = D + E + F + G)	Total health care costs per year (I = C + H)
1	VWF/FVIII concentrate (Fanhdi^®)	384,000	€195,840	12	€38,556	€234,396	30	€620	–	7	2	36	€15,810	8	€1,431	€17,860	€252,256
	VWF with a low FVIII content	216,000	€235,381	2	€13,731	€249,112	16	€331	–	–	–	–	–	–	–	€331	€249,442
2	VWF/FVIII concentrate (Haemate^® P)	360,000	€167,537	30	€87,957	€255,494	16	€331	–	–	–	12	€3,252	–	–	€3,583	€259,077
	VWF with a low FVIII content	192,000	€209,228	–	–	€209,228	8	€165	–	–	–	–	–	–	–	€165	€209,393
3	VWF/FVIII concentrate (Haemate^® P)	504,000	€234,552	12	€58,638	€293,190	36	€744	–	–	–	4	€1,084	4	€715	€2,543	€295,733
	VWF with a low FVIII content	288,000	€313,842	–	–	€313,842	12	€248	–	–	–	–	–	–	–	€248	€314,089
4	VWF/FVIII concentrate (Haemate^® P)	504,000	€234,552	2	€9,773	€244,325	8	€165	€391	4	1	5	€4,397	2	€358	€5,311	€249,636
	VWF with a low FVIII content	336,000	€366,148	–	–	€366,148	2	€41	€55	–	–	–	–	–	–	€96	€366,245

Abbreviations: FVIII, factor VIII; VWF, von Willebrand factor; -, 0; IU, International Unit.

Table 2 Indirect costs

Case report	Drug	Work days lost per bleeding episodes, n	Total indirect cost – loss of productivity per year
1	VWF/FVIII concentrate (Fanhdi^®)	15	€2,334
	VWF with a low FVIII content	3	€467
2	VWF/FVIII concentrate (Haemate^® P)	26	€4,045
	VWF with a low FVIII content	2	€311
3	VWF/FVIII concentrate (Haemate^® P)	36	€5,601
	VWF with a low FVIII content	4	€622
4	VWF/FVIII concentrate (Haemate^® P)	NA	NA
	VWF with a low FVIII content	NA	NA

Abbreviations: FVIII, factor VIII; VWF, von Willebrand factor; NA, not available.

Figure 1 Resume of health care cost and indirect cost for Case report 1.

Abbreviations: FVIII, factor VIII; VWF, von Willebrand factor.

Figure 2 Resume of health care cost and indirect cost for Case report 2.

Abbreviations: FVIII, factor VIII; VWF, von Willebrand factor.

Figure 3 Resume of health care cost and indirect cost for Case report 3.

Abbreviations: FVIII, factor VIII; VWF, von Willebrand factor.

Figure 4 Resume of health care cost and indirect cost for Case report 4.

Abbreviations: FVIII, factor VIII; VWF, von Willebrand factor.

Table 3 Costs in Case 1

Type	Value
	VWF/FVIII concentrate (Fanhdi^®)	VWF with a low FVIII content
Cost of long-term prophylaxis treatment per year (A)	€195,840	€235,381
Cost of bleeding episodes (replacement therapy) per year (B)	€38,556	€13,731
Pharmaceutical costs per year (C = A + B)	€234,396	€249,112
Health care costs (without pharmaceutical costs) per patient year (D)	€17,860	€331
NHS perspective: total direct health cost per year (E = C + D)	€252,256	€249,442
Indirect cost per patient year (F)	€2,334	€467
Social perspective total cost per patient year (G = E + F)	€254,590	€249,909

Abbreviations: FVIII, factor VIII; VWF, von Willebrand factor; NHS, National Health System.

Table 4 Costs in Case 2

Type	Value
	VWF/FVIII concentrate (Haemate^® P)	VWF with a low FVIII content
Cost of long-term prophylaxis treatment per year (A)	€167,537	€209,228
Cost of bleeding episodes (replacement therapy) per year (B)	€87,957	€0
Pharmaceutical costs per year (C = A + B)	€255,494	€209,228
Health care costs (without pharmaceutical costs) per patient year (D)	€3,583	€165
NHS perspective: total direct health cost per year (E = C + D)	€259,077	€209,393
Indirect cost-loss productivity per patient year (F)	€4,045	€311
Social perspective total cost per patient year (G = E + F)	€263,121	€209,704

Abbreviations: FVIII, factor VIII; VWF, von Willebrand factor; NHS, National Health System.

Table 5 Costs in Case 3

Type	Value
	VWF/FVIII concentrate (Haemate^® P)	VWF with a low FVIII content
Cost of long-term prophylaxis treatment per year (A)	€234,552	€313,842
Cost of bleeding episodes (replacement therapy) per year (B)	€58,638	€0
Pharmaceutical costs per year (C = A + B)	€293,190	€313,842
Health care costs (without pharmaceutical costs) per patient year (D)	€2,543	€248
NHS perspective: total direct health cost per year (E = C + D)	€295,733	€314,089
Indirect cost-loss productivity per patient year (F)	€5,601	€622
Social perspective total cost per patient year (G = E + F)	€301,333	€314,712

Abbreviations: FVIII, factor VIII; VWF, von Willebrand factor; NHS, National Health System.

Table 6 Costs in Case 4

Type	Value
	VWF/FVIII concentrate (Haemate^® P)	VWF with a low FVIII content
Cost of long-term prophylaxis treatment per year (A)	€234,552	€366,148
Cost of bleeding episodes (replacement therapy) per year (B)	€9,773	€0
Pharmaceutical costs per year (C = A + B)	€244,325	€366,148
Health care costs (without pharmaceutical costs) per patient year (D)	€5,311	€96
NHS perspective: total direct health cost per year (E = C + D)	€249,636	€366,245
Indirect cost-loss productivity per patient year (F)	NA	NA
Social perspective total cost per patient year (G = E + F)	NA	NA

Abbreviations: FVIII, factor VIII; VWF, von Willebrand factor, NHS, National Health System; NA, Not Available.

Table 7 Net impact of switch from VWF/FVIII concentrates to VWF with a low FVIII content

Case	Total health care cost, without pharmaceutical cost avoided with VWF with a low FVIII content per patient/year	Pharmaceutical cost avoided with VWF with a low FVIII content per patient/year	Indirect cost avoided with VWF with a low FVIII content per patient/year
1	€17,530	−€14,716	€1,867
2	€3,417	€46,266	€3,734
3	€2,295	−€20,652	€4,978
4	€5,215	−€121,824	NA

Abbreviations: FVIII, factor VIII; VWF, von Willebrand factor; NA, not available.