Pediatric Hematology/Oncology and Immunopathology

Economic evaluation of treatment of episodes of slight and moderate hemorrhages in patients with inhibitory hemophilia in Russia

Today the first line therapy for arresting slight and moderate hemorrhages in patients with inhibitory hemophilia in Russia includes activated recombinant factor VII (rFVIIa) and activated prothrombin concentrate complex (aPCC). We analyzed the economic effi ciency of treatment by these two drugs. A decision making model for evaluating the direct medical expenditures was created. Analysis of actual expenditures is based on evaluation of 49 episodes of hemorrhage arrest by rFVIIa in 10 patients for the peri od from December, 2003 to January, 2006, in Russia. Analysis of expenditure for hemorrhage arrest by aPCC is based on pub lished data (no sufficient data collected by the authors). Clinical results were evaluated from the records in medical files of patients and data collected prospectively. These results were analyzed by a group of Russian expert hematologists. The sensitivity of the model was analyzed by modulating the values of the key variables in the main analysis. The patients were treated in an outpa tient clinic or at home. Total direct medical expenditures for treatment from hemorrhage beginning till arrest were 14 137 and  14 703 US dollars for rFVIIa and aPCC, respectively. Total expenditure for the entire therapeutic process were lower for rFVIIa than for aPCC, though the cost of one bleeding episode arrest by rFVIIa was higher. Hence, the economic efficiency of treatment by rFVIIa was higher than by aPCC. These results recommend rFVIIa as the first line drug for the treatment of inhibitory hemo philia in Russia.