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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 Mar 26 2019
Journal Name
International Journal Of Mathematics And Mathematical Sciences
Stability and Bifurcation of a Prey-Predator-Scavenger Model in the Existence of Toxicant and Harvesting
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In this paper a prey-predator-scavenger food web model is proposed and studied. It is assumed that the model considered the effect of harvesting and all the species are infected by some toxicants released by some other species. The stability analysis of all possible equilibrium points is discussed. The persistence conditions of the system are established. The occurrence of local bifurcation around the equilibrium points is investigated. Numerical simulation is used and the obtained solution curves are drawn to illustrate the results of the model. Finally, the nonexistence of periodic dynamics is discussed analytically as well as numerically.

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Publication Date
Wed Mar 31 2021
Journal Name
Integrative Systematics: Stuttgart Contributions To Natural History
A confirmed record of the European catfish Silurus glanis L., 1758 (Actinopterygii: Siluriformes: Siluridae) from the southern marshes of Iraq, with a new anatomical set of characters to separate S. glanis and S. triostegus
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Publication Date
Wed Jun 07 2023
Journal Name
Journal Of The Turkish-german Gynecological Association
Maternal and neonatal outcomes in adolescent pregnant women with one prior Cesarean section in Baghdad
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Publication Date
Tue May 16 2023
Journal Name
Journal Of Engineering
Experimental Study For a Laminar Natural Convection Heat Transfer From an Isothermal Heated Square Plate With and Without Circular Hole
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An experimental investigation of natural convection heat transfer from an isothermal horizontal,vertical and inclined heated square flat plates with and without circular hole, were carried out in two cases, perforated plates without an impermeable adiabatic hole "open core" and perforated plates with an impermeable adiabatic hole "closed core" by adiabatic plug. The experiments covered the laminar region with a range of Rayleih number of (1.11x106 ≤RaLo≤4.39x106 ), at Prandtle number (Pr=0.7). Practical experiments have been done with variable inclination angles from horizon (Ф=0o ,45o,90o,135oand 180o),facing upward (0o≤Ф<90o), and downward (90o
≤Ф<180o). The results showed that the temperature gradient increases whi

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Publication Date
Sat Dec 24 2022
Journal Name
Iraqi Journal Of Pharmaceutical Sciences ( P-issn 1683 - 3597 E-issn 2521 - 3512)
A Study of the inhibitory effect of Terpinen-4-ol on Amastigote Forms of Leishmania tropica within Macrophages of Mouse in vitro
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It was recorded that Terpinen-4-ol has an anti-parasitic properties, so it will be noteworthy to intensify the studies about this compound.

This study aims to test the effectiveness of terpinen-4-ol on amastigote forms of Leishmania parasite in macrophages.

This effect was studied by adding increasing concentrations  of  Terpinen-4-ol to  culture wells containing mouse macrophages that were previously incubated with the promastigote forms of the parasites for 24 hours .Then, they were incubated for another 24 hours with increasing concentrations of Terpinen-4-ol.  After, Parasites were enumerated into macrophages in wells either treated with Terpinen-4-ol or in control wells.

Treatment with Ter

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Publication Date
Sun Jun 01 2014
Journal Name
Journal Of Accounting And Financial Studies ( Jafs )
The economic effects of money laundering and the role of banking service in combat it: a prospective study of a sample
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Money laundering is consider a crime in legal perspective and aphenomenon of negative effects in economic and Social perspective for thevarious countries of the world by the diversity of their economies to make thebadly damaged in the banking service and its reputation in some cases may leadto bankruptcy of banks, and the fact that banks is one of the most importantcircles that revolve the illicit funds, Due to its branched the banking operations,speed and overlap and increase it's complicated with the progress of bankingoperations and the use of electronic services modern here's challenges atvarious levels between the application of the legislation to combat moneylaundering and between actual fact it must find ways and means of legislat

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Publication Date
Tue Feb 12 2019
Journal Name
Iraqi Journal Of Physics
A Study of the generation of laser soliton from spontaneous emission by ring cavity with carbon nanotube
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We demonstrate a behavior of laser pulse grows through fiber laser inside and output cavity with a soliton fiber laser based on the multi-wall carbon nanotube saturable absorber (SA), we investigate the effects of a saturable absorber parameter on the mode-locking of a realistic Erbium fiber ring laser. Generalized nonlinear Schrodinger equation including the nonlinear effects as gain dispersion, second anomalous group velocity dispersion (GVD), self phase modulation (SPM), and two photon absorption used to describe pulse evolution. An analytical method has been used to understand and to quantify the role of the SA parameter on the propagation dynamics of pulse laser. We compute the chirp, power, width and phase of the soliton for range

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Publication Date
Sun Jan 10 2021
Journal Name
Acta Medica Iranica
Early Stages Non-Traumatic Avascular Necrosis of Femoral Head Treated by Core Decompression With and Without Platelets Rich Plasma Injection: A Comparative Study
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Core decompression is one of the commonest used techniques in the handling of osteonecrosis of the pre-collapsed head of the femur. Core decompression had succeeded in preserving the hip joint and delaying the requisite for total hip replacement, but it had failed in the induction of osteogenesis in the necrotic area, thus augmenting core decompression with biological agents to induce osteogenic activity. To assess the effects of platelet-rich plasma in non-traumatic avascular necrosis of the hip joint (early stage) after core decompression. Interventional comparative study for twenty-four patients (32 hip joints) with AVN of the head of the femur was involved in this prospective study, and they were separated into two groups of 16

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Publication Date
Wed May 02 2012
Journal Name
Journal Of Planner And Development
The Effect of Time and Place Dimensions on Changing the Quality Dimensions of Sizes of Cities: A Case Study (Baghdad city)
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The city has normal natural state, and the man has a usual movement, change and search for the new .Also, the city has a usual change and transform in its time, place and quality (sizes)structures. The city has a solid memory diving into the past and the future and reflects The real present, and this memory has a timing layers change into real materialistic place making the city has accumulated overlapping circles which is hard to break u , and it broadcasts the lockup timing density ,in which there is no visual record precisely, it is just like((the social record)) that evaluates the un visual relationships between the components and parts of the city (community and form) in a visual quiet exhibition and transform change inside.

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Publication Date
Thu Mar 31 2022
Journal Name
Journal Of The College Of Education For Women
Social Risks and Development Gaps in Iraq: A Social Study in the City of Baghdad
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Social risks posed a great challenge to the development path in Iraq, which resulted in widening the development gaps, whether these gaps were between rural and embargoed areas, or between Iraqi governorates, and the gender gap. Besides, the nature of the reciprocal relationship between the social risks and the development process requires the adoption of development trends that are sensitive to the risks that take upon themselves the prompt and correct response to these risks, away from randomness and confusion that Iraq suffered from for decades. However, currently, the situation has differed a great deal. This is because the size and types of such gaps have widened and become more complicated than before; a matter which has led to hav

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