Budget impact and cost-utility analysis of prophylactic emicizumab versus on-demand bypassing agents for adolescent severe haemophilia A patients with inhibitors in India

• DOI: 10.1016/j.heliyon.2024.e27089
• Publication Date: 2024-03-01T17:34:13Z
• Authors: Yuvaraj Krishnamo...; Dhanajayan Govindan; Narasimhapriyan K...; Marie Gilbert Maj...; Vishnu Shankar Ha...; Vivek Valliappan
• Keywords: Cost–utility analysis; Prophylactic treatment

IntroductionSevere Haemophilia A patients with inhibitors are currently being treated bypassing agents like activated prothrombin complex concentrates (aPCC) and recombinant factor VIIa. Emicizumab is a humanized monoclonal antibody, introduced to reduce the bleeding events, improve treatment adherence, quality of life. However, cost-effectiveness long-term sustainability intervention not studied in low middle income setting India.AimThe primary objective this study was evaluate cost-utility compared traditional severe haemophilia India. Secondary analyze budgetary impact introducing for patient population from perspective public health system India.MethodsMarkov model created compare prophylactic emicizumab therapy against hypothetical cohort 10-year-old adolescents The time horizon 10 years built based on perspective. Cost utility expressed as costs per quality-adjusted life-years (QALYs) gained. All were 2021 US dollars. Probabilistic sensitivity analysis performed check robustness estimates.ResultsProphylactic cost saving negative Incremental Utility Ratio (ICUR) VIIa −853,573 USD (INR -63,109,773), ICUR −211,675 -15,650,403) APCC. estimated total budget treating all India 59,042,000 4,365,329,312) years' (per 295,210 [INR 21,826,646.56]).ConclusionProphylactic when both it less costly more effective