Chhabra Amit, Fogarty Patrick F, Tortella Bartholomew J, Spurden Dean, Alvir José, McDonald Margaret, Hodge Jennifer, Pleil Andreas M
Manag Care. 2018 Oct;27(10):39-50.
To identify international units (IUs) dispensed and consequent expenditures for standard half-life (SHL) versus extended half-life (EHL) recombinant factor VIII (rFVIII) replacement products in hemophilia A patients in a real-world setting.
Two U.S. claims databases were analyzed.
Number of IUs dispensed and quarterly expenditures for rFVIII products were collected from the Optum Clinformatics Data Mart and Truven Health MarketScan Databases. Truven claims were also analyzed for factor IUs dispensed and expenditures for patients with data for ≥3 months before and after switching to an EHL product.
The Optum and Truven databases, respectively, included 276 (SHL, n=243; EHL, n=33) and 500 (SHL, n=409; EHL, n=91) hemophilia A patients. Median quarterly factor IUs dispensed in Optum were 10% higher with EHL versus SHL products over nine quarters, and 45% higher with EHL versus SHL products in Truven over 10 quarters. Median quarterly expenditures in the EHL cohort were 51% (individual quarterly medians range, 1%-101%) higher than in the SHL cohort in Optum and 122% higher (individual quarterly medians range, 1%-189%) in Truven. Twenty-nine Truven patients switched to an EHL product; median factor IUs dispensed varied quarterly. The lowest SHL and highest EHL values occurred in the quarter immediately before switching and the first quarter post-switch, respectively. Overall median quarterly expenditures were higher post-switch; this was consistent over seven quarters.
We found higher expenditures over two years for hemophilia A patients using EHL versus SHL products. Switching to an EHL rFVIII product was associated with variable factor IUs dispensed and consistently higher expenditures.
在真实世界环境中，确定甲型血友病患者使用标准半衰期（SHL）与延长半衰期（EHL）重组凝血因子VIII（rFVIII）替代产品的国际单位（IU）用量及相应支出。
对两个美国索赔数据库进行分析。
从Optum临床信息数据集市和Truven健康市场扫描数据库收集rFVIII产品的IU用量及季度支出数据。还对Truven索赔数据进行分析，以获取转换为EHL产品前后≥3个月有数据的患者的凝血因子IU用量及支出情况。
Optum和Truven数据库分别纳入了276例（SHL，n = 243；EHL，n = 33）和500例（SHL，n = 409；EHL，n = 91）甲型血友病患者。在Optum数据库中，九个季度内EHL产品的季度凝血因子IU用量中位数比SHL产品高10%，在Truven数据库中，十个季度内EHL产品的季度凝血因子IU用量中位数比SHL产品高45%。Optum数据库中EHL队列的季度支出中位数比SHL队列高51%（各季度中位数范围为1% - 101%），Truven数据库中则高122%（各季度中位数范围为1% - 189%）。29例Truven患者转换为EHL产品；季度凝血因子IU用量中位数随季度变化。转换前最后一个季度的SHL用量最低，转换后第一个季度的EHL用量最高。总体而言，转换后季度支出中位数更高；在七个季度内均保持一致。
我们发现，甲型血友病患者使用EHL产品比使用SHL产品在两年内支出更高。转换为EHL rFVIII产品与凝血因子IU用量变化及持续更高的支出相关。
