OBJECTIVES:

Management of hemophilia A includes replacement of factor VIII (FVIII) by intravenous infusion. The recent introduction of extended half-life (EHL) FVIII products has enabled comparison of health care expenditure and volumes of factor dispensed for hemophilia A patients switching from a standard half-life (SHL) to EHL FVIII product.

METHODS:

The Truven Health MarketScan® Research US claims databases (Aug 1, 2014 to Jan 31, 2017) were used to identify direct expenditures and international units (IUs) dispensed for all patients who used SHL (SHL group) and/or EHL (EHL group). Data on patients who switched from an SHL to an EHL FVIII product were captured up to one year before and after the switch. Patients with at least 1 pre and post-calendar quarter of claims available were included in the switching analysis.

RESULTS:

Cross-sectional analysis: In the SHL group (N=415), Six distinct SHL FVIII products were dispensed, with two EHL FVIII products dispensed in the EHL group (N=91). Median FVIII product dispensation per calendar quarter was 46,409 IU (IQR, 12,760-87,670 IU) (SHL) versus 67,375 IU (IQR, 50,524-98,264 IU) (EHL). Median expenditures per calendar quarter were higher for EHL ($135,519; IQR, $100,320-186,557) than for SHL ($61,152; IQR, $18,593-115,845).

Switching analysis: In the EHL group, 29 patients switched from one of three SHL FVIII products to one of two EHL FVIII products during the study period. Total median IU dispensation per calendar quarter increased following the switch from 58,598 IU (pre-switch, SHL) to 68,036 IU (post-switch, EHL; 16% increase). Factor-related expenditure also increased 84% ($76,553, SHL, versus $141,101, EHL).

CONCLUSIONS: This analysis suggests that switching from an SHL to an EHL product is associated with increased IU dispensation, expenditures and variability, including more EHL IU dispensed post-switch than SHL in quarters pre-switch. Further real world analyses incorporating larger numbers of patients should be explored.