An economic analysis of different treatments for bleeding in patients with acquired haemophilia


Background Acquired haemophilia A (AHA), with potentially high risk of morbidity and mortality, occurs as a result of inhibitors against factor VIII. Bleeding due to AHA can be treated with activated prothrombin complex concentrate (aPCC), recombinant activated factor VII (rFVIIa) or recently, recombinant porcine‐sequence factor VIII (rpFVIII). We extended our previous cost‐effectiveness analysis (CEA) comparing rpFVIII against the available traditional options. Methods For high‐titred, haemorrhaging AHA patients treated with either aPCC, rFVIIa or rpFVIII, over the course of 6‐days, a Markov simulation was conducted to evaluate the outcomes when these patients transitioned into any of the four following health states: (1) continuous bleeding, (2) thrombosis, (3) stop bleeding and (4) death, with states (2), (3) and (4) modelled as absorbing states. All model parameters were obtained from the medical literature, except the costs of aPCC, rFVIIa and the factor VIII assay, which came from our institutional data. Results Excluding the cost of the initial treatment on day 0, the total subsequent treatment cost of rFVIIa was substantially more than the costs of aPCC and rpFVIII ($13 925 vs. $1778 vs. $6957, respectively). The average quality‐adjusted life days (QALDs) gained from rpFVIII was lowest (4·89 vs. 4·9 for rFVIIa and 4·91 for aPCC). Overall, aPCC dominated the other two treatments. The model was determined to be robust across the tested ranges for all input variables. Conclusion Based on this economic model, for AHA patients with high titres who were bleeding, aPCC was the most cost‐effective treatment option and may be considered for use if there is no clinical contraindication.