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This section of First Report Managed Care focuses on reporting the latest in health care economics and outcomes research for a variety of treatments and disease states.

Emicizumab-kxwh, which was approved by the FDA in November 2017 to prevent or reduce the frequency of bleeding episodes in patients with hemophilia (HEM) A and FVIII inhibitors, was found to be associated with decreased medication and utilizations costs.

Doug Brink, PharmD, BCPP, clinical pharmacist, Conduent, and colleagues, explained in a poster presentation for AMCP’s eLearning Days: “Patients with severe hemophilia (HEM) A need regular infusions of Factor VIII (FVIII) to avoid bleeding. About 25% develop a FVIII inhibitor that interferes with the effectiveness of FVIII, making it difficult to control bleeding without using high doses of FVIII or a bypassing agent.”

The researchers study consisted of using HEM A patient enrollee data from the MO Healthnet claims data base. Patients who began emicizumab-kxwh treatment between January 2018 and June 2019 were included. The analysis period included six months pre- and post- emicizumab-kxwh-introduction and examined patient demographics, adoption rates, and adherence.

Cost and utilization rates were measured per user per month (PUPM) for both medical services and pharmacy costs—which were determined from claims data and compared to the controls.

The final cohort included 81 patients with HEM A, of which 18 (22%) started emicizumab-kxwh during the study period with the highest number (12) in the 5 to 17 year old age group. Average age of the emicizumab-kxwh group was 12.2 years compared to 12.7 years in the control group. “Adherence to emicizumab-kxwh therapy ranged from 33% to 100% with an overall adherence of 95%,” found the researchers.

In the six month window prior to the introduction of emicizumab-kxwh initiation, pharmacy costs PUPM were $45,209 for the emicizumab-kxwh group and $4,283 for the control, medical cost PUPM, $2,351 and $2,015, respectively, and medical utilization PUPM (1.46 and 1.41) was similar between the two groups.

“Six months after emicizumab-kxwh initiation, pharmacy cost PUPM decreased $8,122 (18.0%) in the emicizumab-kxwh group, compared to $1,000 (2.4%) in the control group, driven by decreases in HEM drug cost ($8,179 and $1,015, respectively),” stated the reseachers. “Medical cost and utilization PUPMs also decreased to a greater extent in the emicizumab-kxwh group compared to the control group ($1,059 [45.1%] and $49 [2.4%]; 0.43 [29.3%] and 0.07 [5.2%], respectively).”

“In this analysis, emicizumab-kxwh therapy was associated with a decrease in the cost of HEM medications and cost and utilization of medical services,” concluded Dr Moore and colleagues.

—Edan Stanley


Brink D, Moore J, Powell KM, Sheen JV, Williams A. Uptake of Emicizumab-kxwh (Hemlibra®) in the MO HealthNet Population and Impact on Medical and Pharmacy Cost and Utilization. Poster presented at the AMCP eLearning Days, April 20–24, 2020.


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