December 10, 2018

aPCC more cost-effective than rFVIIa in acquired bleeding

There are two options for treating bleeding in patients with acquired haemophilia A and inhibitors: activated prothrombin complex concentrate (aPCC) or recombinant activated factor VII (rFVIIa). The older technology is 7 – 8 times less expensive and, say US analysts, offers a more cost effective option (Vox Sang 2018 Nov 30. doi: 10.1111/vox.12726).

Their research, based on a model of outcomes and costs over a 5 day period rather than a prospective study, found that the impact of the two treatments on quality of life was much the same.

An analysis of outcomes in 56 patients in the FEIBA in the Acquired haemophilia Italian Registry (FAIR) reports the effectiveness of prophylaxis with low-dose aPCC (44 – 61 IU/kg) in 15 patients, beginning after successful treatment of a bleeding episode and continued for about three weeks (Thromb Res 2018 Article in Press). The overall rate of bleeding relapse in the registry 88% but, among those who received low-dose prophylaxis, it was 9%. No thromboembolic events were reported.

The management of acquired haemophilia A and acquired von Willebrand disease is reviewed in two recent papers (Transfus Apher Sci 2018 Oct 30. doi: 10.1016/j.transci.2018.10.011and Transfus Apher Sci. 2018 Oct 30.. doi: 10.1016/j.transci.2018.10.012).