Cost-utility analysis of factor VIII diet therapies prepared using blood plasma vs. recombinant technique for patients with hemophilia A

Farhad Lotfi; Hamid Talebianpour; Khosro Keshavarz; Fatemeh Emadi; Mohammad Reza Bordbar; Peivand Bastani

doi:10.1007/s40199-020-00347-8

Cost-utility analysis of factor VIII diet therapies prepared using blood plasma vs. recombinant technique for patients with hemophilia A

Daru. 2020 Jun;28(1):287-293. doi: 10.1007/s40199-020-00347-8. Epub 2020 Apr 22.

Authors

Farhad Lotfi¹, Hamid Talebianpour², Khosro Keshavarz¹, Fatemeh Emadi³, Mohammad Reza Bordbar⁴, Peivand Bastani⁵

Affiliations

¹ Health Human Resources Research Center, School of Management and Medical Informatics, Shiraz University of Medical Sciences, Shiraz, Iran.
² Department of health management and health economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
³ School of pharmacy and Medical Sciences, University of South Australia , Adelaide, SA, Australia.
⁴ Medical School, Shiraz University of Medical Sciences, Shiraz, Iran.
⁵ Health Human Resources Research Center, School of Management and Medical Informatics, Shiraz University of Medical Sciences, Shiraz, Iran. bastanip@sums.ac.ir.

Abstract

Background: Hemophilia is known as one of the most common coagulation disorders whose treatment costs are particularly high in developing countries, and about 90% of them are related to factor VIII (FVIII) and direct medical costs (DMCs). Thus, the present study aimed to analyze cost-utility of two FVIII diet therapies prepared using blood plasma and recombinant technique.

Methods: This study was an economic evaluation fulfilled through a cost-utility approach. To this end, a total number of 120 patients were randomly selected using Krejcie & Morgan's Table and then received blood plasma and recombinant FVIII. The decision tree structure was also utilized to estimate economic and clinical outcomes. Moreover, costs were reviewed from societal perspective. Quality-adjusted life year (QALY) was subsequently determined as the measure of effectiveness (MOE). Besides, one-way (univariate) sensitivity analysis was performed to quantify uncertainty effects of the study parameters. The information was ultimately analyzed using the TreeAge Pro 2011 and the Microsoft Office Excel 2010 software.

Results: The results revealed that the recombinant diet therapy had higher costs and effectiveness compared with blood-plasma-derived FVIII, so that the mean costs of these two diet therapies were equal to 37,624 and 20,349 purchasing power parity (PPP) $ with utility scores of 0.78 and 0.62; respectively. Since the incremental cost-effectiveness ratio (ICER) for the recombinant medications was over three times of the threshold level, it was considered as overwhelming because of its high cost in spite of its better effectiveness. Moreover, the results of one-way (univariate) sensitivity analysis demonstrated the highest sensitivity to the utility in patients who had been injected with blood-plasma-derived FVIII and had been successfully treated.

Conclusion: The study results revealed that FVIII prepared using blood plasma for hemophilia A patients had higher cost-effectiveness compared with that made using recombinant technique. Graphical abstract.

Keywords: Blood plasma; Cost-utility; Factor VIII; Hemophilia; Recombination.

Publication types

Comparative Study

MeSH terms

Cost-Benefit Analysis
Factor VIII / economics*
Factor VIII / genetics
Factor VIII / therapeutic use*
Hemophilia A / diet therapy*
Hemophilia A / economics*
Humans
Plasma*
Quality-Adjusted Life Years
Recombinant Proteins / economics
Recombinant Proteins / therapeutic use
Treatment Outcome

Substances

Recombinant Proteins
Factor VIII