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Economic analysis of not running tenders for recombinant Factor VIII procurement: a simplified analysis to estimate an otherwise unknown pharmacoeconomic index
  1. Dario Maratea,
  2. Valeria Fadda,
  3. Sabrina Trippoli,
  4. Andrea Messori
  1. HTA Unit, ESTAV Toscana Centro, Regional Health Service, Firenze, Italy
  1. Correspondence to Dr Andrea Messori, HTA Unit, Area Vasta Centro Toscana Regional Health System, Via Guimaraes 9-11, Prato 59100, Italy;{at}


Background Two approaches to the procurement of recombinant Factor VIII products are used by health systems: (A) the most common approach where acquisition tenders are not carried out; (B) the approach tested in the UK in which procurement is based on tenders. The respective cost-effectiveness is not known.

Objective To estimate the incremental cost-effectiveness ratio (ICER) for the comparison A vs B.

Methods The analysis evaluated: (i) Factor VIII cost with/without tenders; (ii) inhibitor development caused by switching between products; (iii) clinical and economic consequences of inhibitors. Information on these items was obtained from a literature search. Because of the scarce evidence available on some items, our analysis considered the ‘most favourable’ scenario—that is, some extreme though reasonable assumptions were adopted that were intentionally biased towards improving the ICER of the no-tender option.

Results and discussion We estimated an ICER for A vs B of £486 409 (€657 139; £1=€1.351) per quality-adjusted life year (QALY). Since pharmacoeconomic thresholds are ∼£30 000 per QALY, our results indicate that the cost-effectiveness of acquisition strategies that avoid tenders is prohibitive. Because of the simplified nature of our analysis, this estimate is preliminary.

Conclusions The ‘true’ ICER of A vs B remains unknown, but its value is likely to be even worse than the unfavourable ICER of £486 409 (€657 139) per QALY.


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