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Cost-effectiveness of on-demand rFVIIa vs prophylactic emicizumab in hemophilia a with inhibitors: clinical, QoL, and ICER-based field insights
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Abstract<sec> <title>Objective

To evaluate the cost-effectiveness of emicizumab compared to recombinant activated factor VII (rFVIIa) in Iraqi patients with hemophilia A and inhibitors.

Method

A retrospective cost-effectiveness analysis was conducted on 46 male patients with hemophilia A and inhibitors treated at a public children’s hospital in Baghdad. Data collection was conducted between November 2024 and March 2025. Clinical and economic data were retrospectively collected for a 12-month follow-up for each of rFVIIa and then emicizumab, including bleeding episodes, emergency visits, treatment costs, and health-related quality of life assessed via EQ-5D-5L (adults) and EQ-5D-Y-3 L proxy (children). Quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios were calculated.

Results

Emicizumab improved mean utility scores from 0.10 to 1.00 in children and from 0.32 to 0.89 in adults, corresponding to an incremental cost of –$2726.36 and –$4304.78 per QALY, respectively (indicating cost savings). Annual bleeding episodes dropped from 8.70 to 0, saving $282.04 per episode. Hospitalization costs decreased significantly, resulting in a total saving of $286650.41 per hospitalization prevented. Use of emicizumab also reduced overall healthcare resource utilization, eliminating emergency department visits, and minimizing diagnostic procedures.

Conclusion

Emicizumab delivers substantial clinical and economic benefits over rFVIIa. Its capacity to enhance quality of life while reducing treatment costs positions it as a cost-effective option for adults and children with hemophilia A and inhibitors in resource-constrained settings. Health authorities should prioritize emicizumab over rFVIIa for patients with hemophilia A and inhibitors, due to its superior efficacy and cost-effectiveness.

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Publication Date
Tue Dec 01 2015
Journal Name
Journal Of Engineering
Digital Image Authentication Algorithm Based on Fragile Invisible Watermark and MD-5 Function in the DWT Domain
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Using watermarking techniques and digital signatures can better solve the problems of digital images transmitted on the Internet like forgery, tampering, altering, etc. In this paper we proposed invisible fragile watermark and MD-5 based algorithm for digital image authenticating and tampers detecting in the Discrete Wavelet Transform DWT domain. The digital image is decomposed using 2-level DWT and the middle and high frequency sub-bands are used for watermark and digital signature embedding. The authentication data are embedded in number of the coefficients of these sub-bands according to the adaptive threshold based on the watermark length and the coefficients of each DWT level. These sub-bands are used because they a

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Publication Date
Sun Sep 27 2020
Journal Name
Iraqi National Journal Of Nursing Specialties
Effectiveness of an Education Program on Nursing Staffs' Knowledge about Infection Control Measures at Intensive Care Unit in Al-Diwaniya Teaching Hospital
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Objectives: To determine the effectiveness of the educational program on nursing staff knowledge about infection control measures at the Intensive Care Unit in Al-Diwaniya Teaching Hospital.

Methodology: A pre-experimental design (one group design: pre-test and post-test) was used. This study was conducted in Al-Diwaniya Teaching Hospital for the period from ( 20th February to 5th March, 2020) on a non-probability (purposive) sample consisting of (25 nurses) working in ICU. A questionnaire was built as a data collection tool and consisted of two parts:

First part: The demographic characteristics of the nursing staff (age, gender, level of education, years of experien

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Publication Date
Fri Sep 01 2023
Journal Name
Journal Of Engineering
Impact of Sulfate in the Sand on the Compressive Strength of Metakaolin-Based Geopolymer Mortar
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The advancement of cement alternatives in the construction materials industry is fundamental to sustainable development. Geopolymer is the optimal substitute for ordinary Portland cement, which produces 80% less CO2 emissions than ordinary Portland cement. Metakaolin was used as one of the raw materials in the geopolymerization process. This research examines the influence of three different percentages of sulfate (0.00038, 1.532, and 16.24) % in sand per molarity of NaOH on the compressive strength of metakaolin-based geopolymer mortar (MK-GPM). Samples were prepared with two different molarities (8M and 12M) and cured at room temperature. The best compressive strength value (56.98MPa) was recorded with 12M w

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Publication Date
Tue Mar 04 2008
Journal Name
Journal Of Baghdad College Of Dentistry
Twelve months clinical comparison between modified Widman flap with or without enamel matrix derivative for the treatment of infrabony defects
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Publication Date
Tue Aug 25 2020
Journal Name
Journal Of Clinical Medicine
Self-Limiting versus Rotary Subjective Carious Tissue Removal: A Randomized Controlled Clinical Trial—2-Year Results
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Background: the aim of this study was to assess the 2-year pulp survival of deep carious lesions in teeth excavated using a self-limiting protocol in a single-blind randomized controlled clinical trial. Methods: At baseline, 101 teeth with deep carious lesions in 86 patients were excavated randomly using self-limiting or control protocols. Standardized clinical examination and periapical radiographs of teeth were performed after 1- and 2-year follow-ups (REC 14/LO/0880). Results: During the 2-year period of the study, 24 teeth failed (16 and 8 at T12 and T24, respectively). Final analysis shows that 39/63 (61.9%) of teeth were deemed successful (16/33 (48.4%) and 23/30 (76.6%) in the control and experimental groups, respectively wit

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Publication Date
Fri Dec 23 2022
Journal Name
Iraqi Journal Of Pharmaceutical Sciences ( P-issn 1683 - 3597 E-issn 2521 - 3512)
Aspirin Derivatives Exploration: A Review on Comparison Study with Parent Drug
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In recent decades, drug modification is no longer unusual in the pharmaceutical world as living things are evolving in response to environmental changes. A non-steroidal anti-inflammatory drug (NSAID) such as aspirin is a common over-the-counter drug that can be purchased without medical prescription. Aspirin can inhibit the synthesis of prostaglandin by blocking the cyclooxygenase (COX) which contributes to its properties such as anti-inflammatory, antipyretic, antiplatelet and etc. It is also being considered as a chemopreventive agent due to its antithrombotic actions through the COX’s inhibition. However, the prolonged use of aspirin can cause heartburn, ulceration, and gastro-toxicity in children and adults. This review article hi

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Publication Date
Thu Oct 21 2021
Journal Name
Physical Review E
Lattice Boltzmann method with moment-based boundary conditions for rarefied flow in the slip regime
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Publication Date
Sun Jan 01 2023
Journal Name
Aip Conference Proceedings
Design and establishment of an implementation program to simulate the far field propagation for a Gaussian beam of x-ray laser
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Publication Date
Wed Mar 29 2023
Journal Name
Iraqi Journal Of Chemical And Petroleum Engineering
Multi-Stage Hydraulic Fracturing Completion Design Based on Ball-and-Sleeve Method
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This paper proposes a completion that can allow fracturing four zones in a single trip in the well called “Y” (for confidential reasons) of the field named “X” (for confidential reasons). The steps to design a well completion for multiple fracturing are first to select the best completion method then the required equipment and the materials that it is made of. After that, the completion schematic must be drawn by using Power Draw in this case, and the summary installation procedures explained. The data used to design the completion are the well trajectory, the reservoir data (including temperature, pressure and fluid properties), the production and injection strategy. The results suggest that multi-stage hydraulic fracturing can

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Publication Date
Mon Apr 15 2024
Journal Name
Journal Of Engineering Science And Technology
Text Steganography Based on Arabic Characters Linguistic Features and Word Shifting Method
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In the field of data security, the critical challenge of preserving sensitive information during its transmission through public channels takes centre stage. Steganography, a method employed to conceal data within various carrier objects such as text, can be proposed to address these security challenges. Text, owing to its extensive usage and constrained bandwidth, stands out as an optimal medium for this purpose. Despite the richness of the Arabic language in its linguistic features, only a small number of studies have explored Arabic text steganography. Arabic text, characterized by its distinctive script and linguistic features, has gained notable attention as a promising domain for steganographic ventures. Arabic text steganography harn

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