OBJECTIVES: To assess the cost-utility of emicizumab prophylaxis compared with patients who were episodic treatment with bypassing agents (BPAs) or BPAs prophylaxis and its possible budget impact in hemophilia A (HA) patients with inhibitors from the societal perspective of Thai government.

METHODS: A Markov model was conducted to estimate the cost-effectiveness of and budget impact of emicizumab prophylaxis over a life-time horizon from a public healthcare payer's perspective. The model was populated using treatment efficacy from clinical trials, cost and epidemiological data retrieved through an extensive literature review. A discount rate of 3% was applied.

RESULTS: Base-case analysis showed that compared with BPAs prophylaxis, emicizumab prophylaxis was found to be more effective (18.1 quality adjusted life years) and cost-saving (–138 million Thai Baht [THB] per patient lifetime) in a cohort of 2-year-old patients with HA and inhibitors. When compared with episodic treatment with BPAs, emicizumab prophylaxis was found to be more effective (30.5 quality adjusted life years) and cost-saving (– 25 million Thai Baht [THB] per patient lifetime). use of emicizumab prophylaxis yielded an overall budget reduction of 82.5 million THB in the next 5 years.

CONCLUSIONS: The clinically effective emicizumab prophylaxis is lowering the risk of bleeding, prolonging life expectancy as well as improving health related quality of life can be considered a cost-saving treatment for preventing bleeding events in HA with inhibitor patients in Thailand. Our findings will support the policy decision making process in Thailand.