Cryoprecipitate <scp>AHF</scp> vs. fibrinogen concentrates for fibrinogen replacement in acquired bleeding patients – an economic evaluation

Okerberg, C. K.; Williams, Lance A.; Kilgore, Meredith L.; Kim, Chong H.; Marques, Marisa B.; Schwartz, Joseph; Pham, Huy P.

doi:10.1111/vox.12417

Cited by 56 publications

(60 citation statements)

References 28 publications

(37 reference statements)

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“…Specifically, we used the costs from our own institution in the model, which reflected better estimates for the cost measurements than the usual reimbursement or Medicare allowance costs that were used in other studies. We further demonstrated the utility of using mathematical models to approach a complex problem in the healthcare setting, and in today's healthcare environment, these models with economic outcomes will be increasingly important for treatment decisions and reimbursements, especially in a complex field such as Transfusion Medicine and Hemostasis/Thrombosis .…”

Section: Discussionmentioning

confidence: 99%

aPCC vs. rFVIIa for the treatment of bleeding in patients with acquired haemophilia – a cost‐effectiveness model

Kim

Simmons²,

Bui³

et al. 2018

Vox Sanguinis

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Background Acquired haemophilia A (AHA) is an autoimmune bleeding disorder with significant morbidity and mortality. Bleeding AHA patients with high titre inhibitors can be treated with either activated prothrombin complex concentrate (aPCC) or recombinant activated factor VII (rFVIIa). Given that both replacement therapies have inherent benefits and limitations, a cost‐effectiveness analysis (CEA) was performed in this population to compare rFVIIa with aPCC. Methods In high‐titered AHA patients with bleeding treated with either aPCC or rFVIIa, during a 5‐day study period, a Markov model was developed such that these patients were transitioned into four different health states: (1) continuous bleeding, (2) thrombosis, (3) stop bleeding and (4) death, with states (2), (3) and (4) modelled as absorbing states. Model parameters, including probabilities, health utility index and costs, were gathered from the medical literature, except for the costs of aPCC and rFVIIa, which were obtained from our institutional data. Results During the 5‐day period, the total treatment cost of rFVIIa was substantially more than the cost of aPCC ($13 635 vs. $1741). The average quality‐adjusted life days (QALDs) gained for rFVIIa were slightly lower compared to aPCC (4·08 vs. 4·09). Overall, aPCC prevailed over rFVIIa. Sensitivity analysis confirmed the robustness of the model across tested ranges of all input variables. Conclusion In high‐titered AHA patients with bleeding, aPCC is a cost‐effective treatment option when compared to rFVIIa. Thus, aPCC may be considered in these patients, if available, and provided there is no clinical contraindication.

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Section: Discussionmentioning

confidence: 99%

aPCC vs. rFVIIa for the treatment of bleeding in patients with acquired haemophilia – a cost‐effectiveness model

Kim

Simmons²,

Bui³

et al. 2018

Vox Sanguinis

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“…After limiting our transfusion volume to 1 unit there was an expected decrease in donor exposure with the same proportion of infants having fibrinogen levels of more than 150 mg/dL after transfusion. The use of pooled fibrinogen products represents an alternative to use of cryoprecipitate from a single donor . To date the use of pooled fibrinogen has not been studied in the NICU setting.…”

Section: Discussionmentioning

confidence: 99%

Cryoprecipitate transfusions in the neonatal intensive care unit: a performance improvement study to decrease donor exposure

Tkach

Mackley²,

Brooks

et al. 2018

Transfusion

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“…These findings emphasize the importance of having an experienced TMA diagnostic and management team for the care of these patients. In today's healthcare environment, CEA will become an important part of the medical decision‐making process . In addition to investigating the issue utilizing a rigorous mathematical modeling with proper sensitivity analysis, the major strength of our study is the utilization of data and costs from multiple studies in the literature, as well as our own institutional costs.…”

Section: Discussionmentioning

confidence: 99%

ADAMTS13 test and/or PLASMIC clinical score in management of acquired thrombotic thrombocytopenic purpura: a cost‐effective analysis

et al. 2017

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Background ADAMTS13 test distinguishes thrombotic thrombocytopenic purpura (TTP) from other thrombotic microangiopathies (TMAs). PLASMIC score helps determine the pretest probability of ADAMTS13 deficiency. Due to inherent limitations of both tests, and potential adverse effects and cost of unnecessary treatments, we performed a cost-effectiveness analysis (CEA) investigating the benefits of incorporating an in-hospital ADAMTS13 test and/or PLASMIC score into our clinical practice. Methods A CEA model was created to compare 4 scenarios for a patient with TMAs, utilizing either an in-house vs. send-out ADAMTS13 assay with or without prior risk stratification using PLASMIC scoring. Model parameters, including probabilities and costs, were gathered from the medical literature, except for the ADAMTS13 send-out and in-house tests, which were obtained from our institutional data. Results If only the cost is considered, in-house ADAMTS13 test for patients with intermediate-high risk PLASMIC score is the least expensive option ($4,732/patient). If effectiveness is assessed as measured by the number of averted deaths, send-out ADAMTS13 test is the most effective. Considering the cost/effectiveness ratio, the in-house ADAMTS13 test in patients with intermediate-high risk PLASMIC score is the best option, followed by the in-house ADAMTS13 test without the PLASMIC score. Conclusions In patients with clinical presentations of TMAs, having an in-hospital ADAMTS13 test to promptly establish the diagnosis of TTP appears to be cost-effective. Utilizing the PLASMIC score increases the cost-effectiveness of the in-house ADAMTS13 test. Our findings indicate the benefit of having a rapid and reliable in-house ADAMTS13 test, especially in the tertiary medical center.

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Cryoprecipitate AHF vs. fibrinogen concentrates for fibrinogen replacement in acquired bleeding patients – an economic evaluation

Abstract: Fibrinogen concentrate is more expensive than cryo, even after adjusting for cryo wastage. To be economically competitive with cryo, FC must cost $414/g, or save on ICU length of stay, consistent with the survey's results.

Cited by 56 publications

References 28 publications

aPCC vs. rFVIIa for the treatment of bleeding in patients with acquired haemophilia – a cost‐effectiveness model

aPCC vs. rFVIIa for the treatment of bleeding in patients with acquired haemophilia – a cost‐effectiveness model

Cryoprecipitate transfusions in the neonatal intensive care unit: a performance improvement study to decrease donor exposure

ADAMTS13 test and/or PLASMIC clinical score in management of acquired thrombotic thrombocytopenic purpura: a cost‐effective analysis

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