Pharmacoeconomic Analysis of the Use of Immune Tolerance Induction Therapy for the Treatment of FVIII Inhibitors in Patients with Hemophilia A in the Healthcare Setting of the Republic of Belarus
One of the most serious problems for a patient that suffers from haemophilia is inhibitor synthesis. Purpose. To assess the feasibility of using immune tolerance induction (ITI) in patients with inhibitory form of haemophilia A by pharmacoeconomic analysis in the conditions of the healthcare system functioning in Republic of Belarus. Materials and Methods. In accordance with national and international documents, literature data, the options for starting ITI in this category of patients were determined. Pharmacoeconomic calculations were carried out using the main methods of pharmacoeconomic analysis: "cost of the disease", "cost minimization", "cost-effectiveness". Results. Two ways of treating patients with haemophilia A are considered: the 1st is a simulation of the patient’s life using one type of therapy (FVIII in haemophilia A in the preventive regimen and on demand; emicizumab in the inhibitory form of haemophilia A; emicizumab in haemophilia A; anti-inhibitor coagulant complex in the inhibitory form haemophilia A in prophylactic regimen and on demand); the 2nd - simulates the natural course of the disease and reflects the risk of inhibitor synthesis, the possibility of therapy by the induction of immune tolerance procedure or a direct transition of a patient with an inhibitory form of haemophilia A to innovative drugs. Costs for the prevention of bleeding, relief of bleeding attacks, procedures for inducing immune tolerance, cost/ effectiveness ratios per patient that started treatment have been calculated. The target population of patients with inhibitory form of haemophilia A, potentially dependent on ITI, was calculated. Conclusion. There is a group of alternative drugs for the treatment of patients with inhibitory form of haemophilia A. However, they require significant costs. ITI is the treatment of choice to eliminate FVIII inhibitors, restore normal FVIII pharmacokinetics, and return the patient to lifelong FVIII use.