Reduction of Costs Associated With the Use of Emicizumab in Prophylaxis in Pediatric Patients Diagnosed With Severe Hemophilia A and Inhibitors in El Salvador

OBJECTIVES: To perform a direct cost comparison between pediatric patients who received immunotolerance with FVIII and bypass agent versus subsequent change of therapy to emicizumab.

METHODS: Clinical records of two pediatric patients with Severe Hemophilia A and inhibitors were analyzed, the first case with a time horizon of two years, the first year received FVIII in immunotolerance and the second year emicizumab. The second case with a time horizon of 1 year, the first 6 months received FVIII and aPCC and subsequently 6 months with emicizumab. In both cases included costs of medications for prophylaxis, immunotolerance or acute bleeding event, the costs of hospitalizations associated with bleeding events were considered. The costs were obtained from public sources in local currency and converted to american dollars according to the national reference rate, the perspective of the analysis is Hospital institution, no indirect costs were included in the analysis.

RESULTS: In the first case, during the period of immunotolerance use, the total annual cost was $159,765, of which $24,801 corresponded to 21 days of hospitalization, the annual cost of emicizumab was $69,970 and did not require hospitalizations.

CONCLUSIONS: The use of emicizumab in prophylaxis for pediatric patients with Hemophilia A in El Salvador reduces direct costs of care. In the present analysis, in the first patient the annual care costs were reduced by 56.21% and in the second patient the six-monthly care costs were reduced by 49.2%.