Switching From Standard to Extended Half-Life Coagulation Factor Replacement in Haemophilia: Clinical Outcomes and Costs of Care in Finland

Abstract

Introduction: Real-world data are needed to evaluate treatment implementation, outcomes and costs of care in haemophilia patients switching prophylaxis from standard half-life (SHL) to extended half-life (EHL) clotting factor concentrates (CFCs). Aim: We characterised treatment regimens, annual bleeding rate (ABR), adherence and costs in a nationwide Finnish haemophilia A (HA) and B (HB) cohort on prophylaxis, including non-switchers and switchers from SHL to EHL CFC. Methods: This retrospective register study of adult patients with HA and HB was performed in University Hospitals during 2016–2021. Clinical and healthcare data were captured from electronic health records and national healthcare registers. Results: Majority, 74% of HA and 71% of HB patients, switched from SHL to EHL. Thereafter, weekly mean infusions of CFC decreased (FVIII SHL 2.8, EHL 2.2; FIX SHL 1.6, EHL 0.9; p < 0.001). The mean annual consumption (international units, IU) increased by 18% from 219,534 per HA patient during SHL to 258,317 during EHL (p < 0.05) and declined per HB patient by 28% from 221,685 to 160,209 (p < 0.01). ABR appeared to decline after the switch in HA (mean SHL 2.8, EHL 0.9) and HB (SHL 1.6, EHL 0.8), while treatment adherence improved in HA from 81% to 95% (p < 0.01). The mean annual total costs of care in HA were €176,979 for SHL and €195,760 for EHL. In HB, the costs increased from €180,930 to €236,208 (p < 0.01). Conclusions: Majority of patients on prophylaxis switched to EHL. The switch alleviated the infusion regimen, tended to lower bleeding rates and improved adherence with somewhat increased costs.