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.
Bibliographical noteFunding Information:
This study was supported by research funding from JW Pharmaceuticals (grant number 2018-11-0268) to the corresponding author, Hye-Young Kang. The funding source had no involvement in the study design; the collection, analysis and interpretation of data; the writing of the report; or the decision to submit the article for publication. We thank the expert panel (Dr. Ki-Young You, Young-Sil Park and Hyo-Chul Kim) for their valuable comments and the Korea Hemophilia Foundation and patients with haemophilia for their support and participation.
© 2020 John Wiley & Sons Ltd
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