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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
Mon Sep 23 2019
Journal Name
Periodicals Of Engineering And Natural Sciences (pen)
Buckling analysis of reinforced composite plates with a multiwall carbon nanotube (MWCNT)
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Publication Date
Wed Apr 01 2020
Journal Name
Applied Acoustics
Wideband sound absorption of a double-layer microperforated panel with inhomogeneous perforation
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Micro-perforated panel (MPP) absorber is increasingly gaining popularity as an alternative sound absorber in buildings compared to the well-known synthetic porous materials. A single MPP has a typical feature of a Helmholtz resonator with a high amplitude of absorption but a narrow absorption frequency bandwidth. To improve the bandwidth, a single MPP can be cascaded with another single MPP to form a double-layer MPP. This paper proposes the introduction of inhomogeneous perforation in the double-layer MPP system (DL-iMPP) to enhance the absorption bandwidth of a double-layer MPP. Mathematical models are proposed using the equivalent electrical circuit model and are validated with experiments with good agreement. It is revealed that the DL-

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Publication Date
Wed May 10 2023
Journal Name
Diagnostics
A Deep Feature Fusion of Improved Suspected Keratoconus Detection with Deep Learning
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Detection of early clinical keratoconus (KCN) is a challenging task, even for expert clinicians. In this study, we propose a deep learning (DL) model to address this challenge. We first used Xception and InceptionResNetV2 DL architectures to extract features from three different corneal maps collected from 1371 eyes examined in an eye clinic in Egypt. We then fused features using Xception and InceptionResNetV2 to detect subclinical forms of KCN more accurately and robustly. We obtained an area under the receiver operating characteristic curves (AUC) of 0.99 and an accuracy range of 97–100% to distinguish normal eyes from eyes with subclinical and established KCN. We further validated the model based on an independent dataset with

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Publication Date
Tue Jun 15 2021
Journal Name
Iraqi Journal Of Pharmaceutical Sciences ( P-issn 1683 - 3597 E-issn 2521 - 3512)
Effects of Exclusive Breast Feeding for First Six Months of life on Children Weight, Height and Head Circumference in Sulaimani City, Kurdistan-Iraq and Compare with Other Types of Feeding
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Breastfeeding (BF) serves as a complete nutritional source for the first six months of infant’s life. Breast milk contains all essential nutrients that necessary for the physiological growth and development of infants. The aim of this study was to compare the physiological growth of infants including weight, height and head circumference who were exclusively breastfed for 6 months and those who were given bottle-fed or mixed fed and to find a percentage of exclusive breastfeeding among mothers who contributed in this study in Sulaimani city. This study was carried out in Sulaimani city/ Kurdistan region of Iraq and the cases were enrolled between the first of October 2018 and first of October 2019. The infants’ weight, height and hea

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Publication Date
Wed Mar 29 2023
Journal Name
Iraqi Journal Of Chemical And Petroleum Engineering
Effect of Heterogeneity on Capillary Pressure and Relative Permeability Curves in Carbonate Reservoirs. A Case Study for Mishrif Formation in West Qurna/1 Oilfield, Iraq
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The special core analysis tests were accomplished on a set of core plugs for Mishrif Formation (mA, mB1, and mB2cde/mC units) in West Qurna/1 oilfield, southern Iraq. Oil relative permeability (Kro) data and the Corey-type fit of the data as functions of the brine saturation at the core outlet face for individual samples in the water-oil imbibition process to estimate relative permeability measurements by the centrifuge method were utilized. Identical correlations for oil and water relative permeabilities were extracted by steady-state and unsteady-state methods. For the mA samples, the gas-water capillary pressure curves were within a narrow range (almost identical) indicating that mA is a homogeneous unit. Kro curves for thr

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Publication Date
Wed Mar 29 2023
Journal Name
Iraqi Journal Of Chemical And Petroleum Engineering
Effect of Heterogeneity on Capillary Pressure and Relative Permeability Curves in Carbonate Reservoirs. A Case Study for Mishrif Formation in West Qurna/1 Oilfield, Iraq
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The special core analysis tests were accomplished on a set of core plugs for Mishrif Formation (mA, mB1, and mB2cde/mC units) in West Qurna/1 oilfield, southern Iraq. Oil relative permeability (Kro) data and the Corey-type fit of the data as functions of the brine saturation at the core outlet face for individual samples in the water-oil imbibition process to estimate relative permeability measurements by the centrifuge method were utilized. Identical correlations for oil and water relative permeabilities were extracted by steady-state and unsteady-state methods. For the mA samples, the gas-water capillary pressure curves were within a narrow range (almost identical) indicating that mA is a homogeneous unit. Kro curves for three mB2

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Publication Date
Wed Jun 01 2022
Journal Name
Journal Of Sport Science Technology And Physical Activities
The effect of using Daniel's model and Driver’s model in learning a kinetic chain on the uneven bars in the artistic gymnastics for female students
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The aim of this study to identity using Daniel's model and Driver’s model in learning a kinetic chain on the uneven bars in the artistic gymnastics for female students. The researchers used the experimental method to design equivalent groups with a preand post-test, and the research community was identified with the students of the third stage in the college for the academic year 2020-2021 .The subject was, (3) class were randomly selected, so (30) students distributed into (3) groups). has been conducted pretesting after implementation of the curriculum for (4) weeks and used the statistical bag of social sciences(SPSS)to process the results of the research and a set of conclusions was reached, the most important of which is t

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Publication Date
Sun May 12 2013
Journal Name
International Journal Of Pharmacy And Pharmaceutical Sciences
PLEIOTROPIC EFFECTS OF ATORVASTATIN ON PRO-INFLAMMATORY CYTOKINES IN NEWLY DIAGNOSED IRAQI PATIENTS WITH TYPE 2 DIABETES MELLITUS
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Objective: Atorvastatin therapy is now recommended for reduction of cardiovascular risk in type 2 diabetic patients (T2DM), based on convincing evidence of reductions in mortality and vascular events in major clinical outcome trials. The aim is to evaluate the effects of atorvastatin on proinflammatory markers (TNF-α, IL-6), HbA1c andleptin in obese patients with type 2 diabetes. Methods: Sixty fivenewly diagnosed T2DM patients were randomly allocated into 2 groups; group I treated with metformin only; in group II atorvastatin was added with metformin. Twenty healthy subjects were enrolled as control group. While maintaining their usual eating habits, fasting blood samples were collected at baseline and after 12 weeks of treatment. Results

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Publication Date
Tue Aug 01 2023
Journal Name
The Nucleus
Studies on the role of retinol binding protien-4 in type 2 diabetic Iraqi patients with metabolic syndrome
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Several adipokines are produced and secreted from adipose tissue, such as retinol binding protein-4, which triggers metabolic syndromes and insulin resistance. Retinol binding protein-4 transfers vitamin A or retinol in the blood. Higher levels of retinol binding protein-4 are interrelated with progress of metabolic disease, comprising obesity, metabolic syndrome, and type 2 diabetes mellitus. The present study investigates the role of retinol-binding protein-4 levels in type 2 diabetic Iraqi patients with metabolic syndrome. Sixty type 2 diabetic patients aged 40–53 years were examined. Of these 30 patients has metabolic syndrome and 30 without metabolic syndrome. The patients sampled were from the National Diabetes Center/ Mustansiriyah

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Publication Date
Sun Jan 01 2017
Journal Name
Journal Of Pharmacy And Biological Sciences
Effect of Oral Zinc Sulfate on Local Inflammatory Cytokines Level in Iraqi Women Infected With Human Papillomavirus (HPV)
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This study was aimed to monitor oral zinc sulfate role on local cervical proinflammatory cytokines in HPV-infected women comparing with these cytokines before treatment application. A cervical secretion got from 28 infected women before and after treatment with zinc sulfate, these samples assessed various markers of inflammation including interleukin-1β, IL-8, and IL-12. Results manifested that improve and clear the cervical HPV infections after three months of zinc treatment 46.43% and 21.43%, respectively. Viral infections with single and multiple HPV high-risk types are raising of studied cytokines after 3-month compared with single HPV low-risk type. Moreover, this increasing was statistically significant only in IL-12 and IL-1. Women

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