Economic Evaluation And Budget Impact Analysis Of Prothrombin Complex Concentrate (Beriplex®) For Treatment And Prophylaxis Of Bleeding In Patients Treated With Oral Anticoagulants Under Perspective Of Health Public Institutions In Mexico

Abstract

Most important adverse event associated with the use of oral anticoagulants is bleeding and sometimes it is necessary to reverse anticoagulation. The objective of this study is to compare the costs of using Prothrombin Complex Concentrate (PCC) in comparison to Fresh Frozen Plasma (FFP) in Health Public Institutions in order to identify the cost-saving anti-bleeding treatment. Since PCC and FFP have the same safety and efficacy profile, a cost-minimization study and budget impact analysis were conducted, by examining the comparison of anti-bleeding treatment in patients with oral anticoagulants (warfarin). Standard of treatment was a 70 Kg patient. Time horizon was considered duration of bleeding episode and there was not applied discount rate. The analysis were presented in 3 scenarios according to International Normalized Index ranges, from 2.0-3.9, 4.0-6.0 and >6.0. Unitary costs and budget were obtained from Health Public Institutions in 2016. In the first scenario, anti-bleeding treatment cost for PCC was $764 USD and for FFP was $1,369 USD (-$615 USD). In the second scenario treatment cost for PCC was $955 USD and for FFP was the same as in first scenario (-$423 USD). In the third scenario treatment cost for PCC was $1,338 USD and for FFP was $1,838 USD (-$500 USD). The cumulative 5-year cost for 10,000 estimated cases of bleeding per year in patients with INR> 6.0 was for PCC $18.7 USD million and for FFP was $25.7 USD million. The 5-year Budget Impact Analysis showed savings for $7 USD million by using PCC, which represent 0.0053% of the entire Mexican public health budget. Sensitivity analysis corroborated results of base cases. PCC is a cost-saving alternative when compared to FFP in treatment and prophylaxis of bleeding in patients treated with oral anticoagulants under perspective of Health Public Institutions in Mexico.