Comparison of bypassing agents in bleeding reduction in treatment of bleeding episodes in patients with haemophilia and inhibitors

A comparison between on-demand usage of rFVIIa vs prophylaxis use of emicizumab in high titer inhibitory hemophilia A patients in Iran: A cost-utility analysis

BACKGROUND

Hemophilia A (HA) is an inherited X-linked bleeding disease with costly treatment, especially for high titer inhibitory patients. Emicizumab, a new humanized bispecific antibody, has been approved for use to prevent or reduce the frequency of bleeding episodes in HA patients with inhibitors. This study evaluated the cost-utility of emicizumab prophylaxis (EP) in comparison with recombinant factor VII activated on-demand treatment in HA patients with inhibitors.

METHODS

A life-time Markov model with payer and societal perspectives was developed in different age groups with different annual bleeding rates (ABR). Efficacy of treatments were extracted from HAVEN trials. Utilities were retrieved from published evidence. Costs were calculated based on Iran food and drug administration official website, national tariff book for medical services and hospital data. One-way deterministic sensitivity analysis was performed.

RESULTS

EP was dominant choice in comparison with on-demand administration of recombinant factor VII activated in all age groups with ABR 20 and 25, and it remained dominant in patients with age 2 and age 12 at start point with ABR 16 and 17. The reported incremental cost-effectiveness ratio for the group with ABR 18 at the age 20, was 12,936 United States Dollars which is lower than the acceptable threshold of cost-effectiveness in Iran (1-3 gross domestic product per capita) and EP can be considered as cost-effective choice in this scenario.

CONCLUSION

EP was found to be a dominant and cost-effective choice for Iranian HA patients with factor VIII inhibitors with ABR 18 and above with considerable cost saving.

Analysis of Provincial Mortalities Among Bus/Minibus Users Over Twelve Years, East Azerbaijan, Iran

Objective: The aim of this study was to investigate the epidemiological features of bus/minibus users' road traffic injury mortalities during 2006-2017, in the East Azerbaijan province of Iran. Methods: All 245 bus/minibus users' mortalities, registered in the forensic medicine database, were analyzed by STATA 13 statistical software package. Results: The majority of victims (mean age: 41.5±18.6 years) were men (70%), adults (79.18%), illiterate (22.4%) and self-employed (25.3%). Passersby and police played an almost null role in transporting victims since 2014. A decreasing trend of bus/minibus users' fatalities was observed over the study time. Head-neck-face trauma was more common among those who died prior to hospitalization. Rollover was significantly prevalent among bus users and falling among minibus users. Lorries, vans, and trailers as crash counterpart vehicles caused 59% of deceases, excluding the cases when no other vehicle was engaged. Victims were more likely to die at the hospital when crashes happened in the city's inner roads (OR: 4.17; 95%CI:1.7-9.9). The elderly were 2.78 times more likely to die at the hospital when compared to the other age groups (95%CI: 1.23-6.26). Conclusions: To identify a target group for interventions on traffic-related knowledge, attitude and behaviors, male adults, illiterate and self-employed bus/minibus users could be of priority. Type vehicles involved in the crash should be considered as an important factor affect on crash fatalities. Further investigations are needed in this regard in the future.

Cost-Effectiveness Analysis of Biogeneric Recombinant Activated Factor VII (AryoSeven™) and Activated Prothrombin Complex Concentrates (FEIBA™) to Treat Hemophilia A Patients with Inhibitors in Iran

Nowadays, bypassing agents such as recombinant activated factor VII (rFVIIa) and activated prothrombin complex concentrates (aPCC) are used to treat bleeding episodes in the Hemophilia patients with inhibitors. AryoSeven® is an Iranian biogeneric rFVIIa with homogeneity of efficacy and the nature to NovoSeven in a comparative trial. The current clinical trial aimed to evaluate the cost-effectiveness of FEIBA and AryoSeven® by Decision Analytic Model according to the Iranian healthcare system. An open label, multi-center, cross-over clinical trial was designed. Patients were categorized into 3 groups based on their prior tendency to one or none of the products. To determine the premium therapeutic strategy, the Incremental cost-effectiveness ratio (ICER) was calculated. Protocol F led to more treatment success in group F than the other groups (P= 0.03). Also, there was a significant statistical difference between the mean of effectiveness scores in the groups using protocol F (P = 0.01). The effectiveness of protocol F and A were 89% and 72%, respectively. ICER cost US$ to manage an episode of bleeding to get one more unit of effectiveness using FEIBA VS. AryoSeven. Although the results showed that AryoSeven was more cost-effective compared to FEIBA, the two strategies were undominated. In other words, both medicines can be applied in the first line of the treatment if the cost of FEIBA was reduced. The present clinical trial was registered at IRCT website, under ID No.2013020612380N1.