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Cost‐utility analysis of emicizumab prophylaxis in haemophilia A patients with factor VIII inhibitors in Korea
Author(s) -
Lee Hankil,
Cho Hyeonseok,
Han Jung Woo,
Kim AhYoung,
Park Seonyoung,
Lee Minjun,
Cho Sunghwa,
Baik Deborah,
Kang HyeYoung
Publication year - 2021
Publication title -
haemophilia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.213
H-Index - 92
eISSN - 1365-2516
pISSN - 1351-8216
DOI - 10.1111/hae.14143
Subject(s) - medicine , haemophilia a , haemophilia , pediatrics , intensive care medicine
Aims Haemophilia A patients with factor VIII inhibitors (HAPI) experience frequent spontaneous bleeding, approximately once a week, and require expensive bypassing agent (BPA) treatments to control bleeding over their lifetime. According to the HAVEN 1 trial, weekly emicizumab (Hemlibra®) prophylaxis injection reduces annualized bleeding rates (ABR) by 87% compared with BPA on‐demand treatment (BPA‐OD) administered at the time of bleeding. Our study aimed to assess the cost‐effectiveness of emicizumab prophylaxis in HAPI in Korea. Methods Using a lifetime Markov model with health states of ‘alive with bleeds’ and ‘dead’, we simulated the experience of HAPI receiving emicizumab prophylaxis (treatment arm) or BPA‐OD (control arm) and estimated expected clinical and economic outcomes under each treatment arm. Model parameters included comparative effectiveness, clinical and epidemiologic characteristics of Korean HAPI, costs of drug treatment and medical events and utility for ‘alive with bleeds’ state under each treatment. We utilized local data, including National Health Insurance claims data, national statistics, literature and expert surveys with haematologists. Results Base‐case analysis results showed that compared with BPA‐OD, lifetime emicizumab prophylaxis prevented 807 bleedings, extended 3.04 quality‐adjusted life‐years and reduced costs by 2.6 million US dollars. Thus, emicizumab prophylaxis is a dominant treatment option with better effectiveness and lower costs than BPA‐OD. A series of one‐way sensitivity analyses consistently showed dominant results, confirming that lifetime emicizumab prophylaxis is a cost‐saving intervention for HAPI. Conclusion Emicizumab prophylaxis is an excellent treatment choice reducing ABR, improving quality of life and reducing costs.