OBJECTIVES

For more than a decade, intravenous (IV) eculizumab delivered biweekly in an infusion clinic has been the standard of care for patients with paroxysmal nocturnal hemoglobinuria (PNH). Recently, ravulizumab, a long-acting C5 complement inhibitor, obtained approval by the FDA for the treatment of PNH. The efficacy of ravulizumab was shown to be non-inferior to eculizumab in treatment-naive and eculizumab-experienced PNH patients, when administered by IV infusion once every 8 weeks. This study compares the lost productivity for PNH patients managed with eculizumab and ravulizumab delivered in an infusion clinic and at home.

METHODS

Using data from the literature and expert opinion, we applied a realistic set of assumptions to establish the total time needed for treatment including administration, recovery, and travel times for each treatment regimen. We multiplied the total duration by the hourly wage of $20 to estimate lost productivity.

RESULTS

Treating 100 PNH patients in clinic for 2 years with eculizumab (“current practice”) is estimated to result in a total duration of 25,920 hours in travel, administration, and recovery, yielding $518,400 in lost productivity. The less frequency of dosing for ravulizumab translates into a reduction of lost productivity for patients in clinic by 64% (lost productivity $184,800). Relative to clinical settings, home treatment reduces lost productivity by 38% ($320,100) and by 70% ($154,000) for eculizumab and ravulizumab, respectively.

CONCLUSIONS

Based on these calculations that incorporate real-world dosing schedules, productivity loss is reduced among PNH patients receiving ravulizumab compared to eculizumab in both clinical and home settings. These estimates can be incorporated into economic evaluations that adopt a societal perspective.