Budget Impact of Andexanet ALFA for Gastrointestinal Bleeding Associated with Factor Xa Inhibitors from a US Hospital Perspective

Author(s)

Deitelzweig S1, Cash BD2, Goldstein JN3, Blissett RS4, Lovelace B5, Christoph MJ5, Fermann G6
1University of Queensland and Ochsner Clinical School, New Orleans, LA, USA, 2University of Texas Health Science Center at Houston, Houston, TX, USA, 3Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA, 4Maple Health Group, LLC, New York, NY, USA, 5Alexion, AstraZeneca Rare Disease, Boston, MA, USA, 6University of Cincinnati, Cincinnati, OH, USA

OBJECTIVE: Oral Factor Xa (FXa) inhibitors are used to treat and prevent thrombotic events but may exacerbate acute major bleeding. This analysis calculated the budget impact of using Andexanet alfa (andexanet), a novel specific reversal agent for FXa inhibitors, to treat FXa inhibitor-related major gastrointestinal bleeding from a US acute care hospital perspective.

METHODS: A decision tree framework over a 2-year time horizon was used to compare andexanet to 4-factor prothrombin complex concentrate (4F-PCC). Hospitalization costs were determined through: (1) the probability of undergoing any initial endoscopy (therapeutic or diagnostic) and (2) the risk of a re-bleeding event within 30 days. Re-bleeding events could then be treated with repeat endoscopy, angiographic embolization, or surgery. Hospitalization costs were assigned based on the level of intervention received. New technology add-on payments (NTAP) were included as an offset against pharmacy acquisition costs for andexanet. Two scenarios were modeled, a world where all patients were treated with 4F-PCC and a world where all patients were treated with andexanet (where patients in both arms could receive additional therapies including FFP, activated 4F-PCC, Vitamin K, and rFactor VIIa). The model assumed that 50 patients received reversal treatment annually with the population growing at a rate of 5% per year.

RESULTS: The budget impact was a net cost reduction of $92,626 ($1,852 per patient) in year 1 and $97,257 in year 2 when comparing a world with andexanet to a world without andexanet, driven by fewer rebleeding events and subsequent procedures. One-way sensitivity analysis showed that the most influential model parameters were the drug costs, dosing assumptions, and risk of re-bleeds.

CONCLUSION: Our analysis suggests that appropriate utilization of andexanet for reversal of FXa inhibitors in the setting of major gastrointestinal bleeding may result in net reductions in hospitalization costs from a US acute care hospital perspective.

Conference/Value in Health Info

2022-05, ISPOR 2022, Washington, DC, USA

Value in Health, Volume 25, Issue 6, S1 (June 2022)

Code

EE391

Topic

Economic Evaluation

Topic Subcategory

Budget Impact Analysis, Cost-comparison, Effectiveness, Utility, Benefit Analysis

Disease

No Additional Disease & Conditions/Specialized Treatment Areas

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