OBJECTIVES: Emicizumab, a bispecific antibody for hemophilia A, is reimbursed in Finland since November 2018. Reimbursement is currently restricted for patients with hemophilia A and factor VIII (FVIII) inhibitors (HAwI) when immunotolerance induction therapy (ITI) is unsuccessful or unsuitable, and for patients with severe hemophilia A without FVIII inhibitors when prophylactic treatment with FVIII is unsuccessful or unsuitable. FVIII treatment is individually tailored based on pharmacokinetic profiling and lifestyle factors, and thereby subject to large individual variation. On HAwI patients, the need for ITI and bypassing agents (BPAs) multiplies the treatment costs compared to regular FVIII prophylaxis. In contrast, emicizumab dosing and associated treatment costs are fixed.

Due to significant variation in the earlier treatment costs, the impact of switching to emicizumab on hemophilia A treatment costs in Finland is not known. We aimed to investigate the treatment cost of HAwI patients before and after emicizumab initiation.

METHODS: All patients who had used emicizumab under the inhibitor reimbursement scheme were identified in the database of the Social Insurance Institution. Reimbursed costs and purchase dates of emicizumab, FVIII, and BPAs per patient were recorded for the duration of emicizumab treatment and three years before the emicizumab switch. Average daily treatment cost per patient was calculated and annualized.

RESULTS: Ten HAwI patients had recurring emicizumab purchases until the end of follow-up (30 June 2022). The average annual treatment costs declined from 269 498 € in year 3 before the emicizumab switch to 147 982 € during emicizumab maintenance. Seven patients had concomitant use of other hemophilia drugs during the emicizumab treatment with the additional average annual cost of 25 919 €.

CONCLUSIONS: Switching to emicizumab reduces drug costs compared to previous treatment for Finnish HAwI patients. There is no significant need for additional bleed control with concomitant medications during emicizumab prophylaxis.