Cost-effectiveness of recombinant activated factor VII in the treatment of intracerebral hemorrhage

Background and Purpose-Intracerebral hemorrhage (ICH) is among the most costly and debilitating forms of stroke. Results from a recent Phase IIb clinical trial demonstrate that administration of recombinant activated factor VII (rFVIIa) reduces ICH mortality and improves functional outcome. In the current analysis, we examine the cost-effectiveness of early treatment with rFVIIa for ICH in the United States. Methods-A decision-analytic model was developed to estimate the lifetime costs and outcomes associated with rFVIIa treatment at doses of 40, 80 and 160 mu g/kg compared with current standard of care in treating ICH, from a US third-party payer perspective. The patient population was similar to that of the Phase IIb clinical trial. Model structure and inputs were obtained from published literature, clinical trial data, claims databases, and expert opinion. All costs are presented in 2005 US dollars. Outcomes included incremental cost per life-year (LY) saved and incremental cost per quality-adjusted life-year (QALY) gained. Costs and outcomes were discounted at 3% annually. Univariate and multivariate sensitivity analyses were conducted to assess model robustness. Results-Compared with standard care, treatment with rFVIIa 40 mu g/kg, and 160 mu g/kg results in total lifetime cost-effectiveness ratios of $6308/QALY and $3152/QALY, respectively. Treatment with rFVIIa 80 mu g/kg was found to be cost saving and a gain of 1.67 QALYs is achieved over a patient's lifetime. These results are robust to changes in input parameters. Conclusions-Treatment of ICH with rFVIIa 40 mu g/kg and 160 mu g/kg appears to be cost-effective (<=$50000/QALY). At the 80 mu g/kg dose, rFVIIa was not only cost-effective, but also cost saving.