OBJECTIVES: Oral Factor Xa inhibitors (oFXai) are used to treat and prevent thrombotic events but may exacerbate acute major bleeding. Andexanet, a modified recombinant inactive form of human F-Xa, is a novel antidote for reversal of oFXai. This study calculated the budget impact of using Andexanet to treat intracranial hemorrhage (ICH) associated with oFXai from a US acute care hospital perspective.

METHODS: A decision tree framework was created to compare a world with Andexanet to a world without, where 4-factor prothrombin complex concentrate (4F-PCC) was used. Andexanet uptake was projected over 3 years based on real-world data. Patients entering the model were assigned a probability of hematoma expansion (≥33% volume increase from baseline). Patients with hematoma expansion were assigned an increased length of intensive care unit stay and increased risk of intubation. Drug costs, cost of ICU days, and intubation costs were included. New technology add-on payments (NTAP) were included as an offset against pharmacy costs for Andexanet. We calculated the costs per hospitalization in the two groups. Key cost drivers were identified using one-way sensitivity analyses.

RESULTS: The costs per hospitalization were $48,303 for Andexanet and $52,179 for 4F-PCC when NTAP was included. We projected a cost savings of $84,994 in year 1 to $102,843 in year 3 when comparing a world with Andexanet to one without. The most influential model parameters were the drug costs, Andexanet dosing assumptions and the probability of hematoma expansion.

CONCLUSIONS: Our analysis suggests that increasing Andexanet uptake in the treatment of oFXai reversal may result in net reductions in the costs to an acute care hospital.