OBJECTIVES The standard of care for patients with atypical haemolytic uremic syndrome (aHUS) is the complement 5 (C5) inhibitor eculizumab which is infused intravenously every two weeks. Ravulizumab, a novel, longer-acting C5 inhibitor, is under investigation in patients with complement-mediated thrombotic microangiopathy including aHUS, with infusions every eight weeks. Both treatments can be administered in a clinic or at home. The objective of this study was to estimate productivity loss of treating aHUS patients in the US with eculizumab or ravulizumab in an infusion clinic or at home.

METHODS The model included an induction phase for each regimen. Doses were determined separately for infants, children, adolescents, and adults according to weight. The aggregate duration of treatment included travel, infusion and recovery time, and was estimated using data from the literature, expert opinion, and clinical trial protocols. Lost productivity costs (presented as annual costs) were calculated by multiplying the aggregate duration of therapy by the US hourly wage rate (US 2019 $20; assuming time spent in leisure scholastically and earning income were of equal value).

RESULTS Over one year of treatment, the estimated aggregate duration of therapy per 100 patients (25 in each weight category) was 22,690 hours with eculizumab in clinic, 14,760 hours with eculizumab at home, 9,000 hours with ravulizumab in clinic, and 6,060 with ravulizumab at home. Productivity costs were approximately $454,000 for eculizumab in clinic, and were reduced by 35% for eculizumab at home, by 60% for ravulizumab in clinic, and by 73% for ravulizumab at home.

CONCLUSIONS Our findings indicate that patients receiving ravulizumab at home spend less time in treatment, which, in turn, reduces productivity loss, compared with patients treated with eculizumab in a clinic. These estimates can be used to populate economic evaluations of aHUS treatment from a societal perspective in the US.