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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
Sat Sep 30 2017
Journal Name
College Of Islamic Sciences
Book of Musaka (by Imam Abu al-Qasim Abdul-Karim Muhammad ibn Abd al-Karim al-Rafii)
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Al-Aziz's book was chosen as a subject for research as it is one of the important books in the Islamic world in general and the Shafi'i school in particular and its author Imam Abdul Karim bin Mohammed bin Abdul Karim Al-Rafi's, who in the doctrine of the jurisprudence has made prominent lines and left behind invaluable scientific treasures in the service of religion. Its importance is summarized as follows:
1. Being an explanation of the book (brief) of the argument of Islam Imam Ghazali (God's mercy), one of the five books adopted in Shafi'i jurisprudence.
2. His work is Imam Abu al-Qasim al-Rafii known for the brilliance of the investigation and the power of weighting in the doctrine.
3. It is considered an encyclopedia in Sh

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Publication Date
Wed May 01 2019
Journal Name
Journal Of Engineering
Optimization of Friction Stir Welding Process Parameters to joint 7075-T6 Aluminium Alloy by Utilizing Taguchi Technique
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In this study, a 3 mm thickness 7075-T6 aluminium alloy sheet was used in the friction stir welding process. Using the design of experiment to reduce the number of experiments and to obtain the optimum friction stir welding parameters by utilizing Taguchi technique based on the ultimate tensile test results. Orthogonal array of L9 (33) was used based on three numbers of the parameters and three levels for each parameter, where shoulder-workpiece interference depth (0.20, 0.25, and 0.3) mm, pin geometry (cylindrical thread flat end, cylindrical thread with 3 flat round end, cylindrical thread round end), and thread pitch (0.8, 1, and 1.2) mm) this technique executed by Minitab 17 software. The results showed th

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Publication Date
Wed Jun 01 2022
Journal Name
Journal Of Engineering
Extraction of Manganese Element from Electric Arc Furnace Steel Slag (EAFS) by Liquid-liquid extraction (LLE) method
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This research investigates manganese (Mn) extraction from Electric Arc Furnace Steel Slag (EAFS) by using the Liquid-liquid extraction (LLE) method. The chemical analysis was done on the slag using X-ray fluorescence, X-ray diffraction, and atomic absorption spectroscopy. This work consisted of two parts: the first was an extensive study of the effect of variables that can affect the leaching process rate for Mn element from slag (reaction time, nitric acid concentration, solid to liquid ratio, and stirring speed), and the second part evaluates the extraction of Mn element from leached solution. The results showed the possibility of leaching  83.5 % of  Mn element from the slag at a temperature of 25°C, nitric acid co

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Publication Date
Mon Jan 01 2024
Journal Name
Journal Of Engineering
Improving the Direction of Arrival Estimation Using the Parasitic Subspace Generated by Active-Parasitic Antenna (APA) Arrays
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The improvement in Direction of Arrival (DOA) estimation when the received signals impinge on Active-Parasitic Antenna (APA) arrays will be studied in this work. An APA array consists of several active antennas; others are parasitic antennas. The responses to the received signals are measured at the loaded terminals of the active element. The terminals of the parasitic element are shorted. The effect of the received signals on the parasites, i.e., the induced short-circuit current, is mutually coupled to the active elements. Eigen decomposition of the covariance matrix of the measurements of the APA array generates a third subspace in addition to the traditional signal and noise subspaces generated by the all-active ante

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Publication Date
Sat Dec 02 2023
Journal Name
Journal Of Engineering
Performance Assessment of Pile Models Chemically Grouted by Low-Pressure Injection Laboratory Device for Improving Loose Sand
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The complexity and partially defined nature of jet grouting make it hard to predict the performance of grouted piles. So the trials of cement injection at a location with similar soil properties as the erecting site are necessary to assess the performance of the grouted piles. Nevertheless, instead of executing trial-injected piles at the pilot site, which wastes money, time, and effort, the laboratory cement injection devices are essential alternatives for evaluating soil injection ability. This study assesses the performance of a low-pressure laboratory grouting device by improving loose sandy soil injected using binders formed of Silica Fume (SF) as a chemical admixture (10% of Ordinary Portland Cement OPC mass) to di

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Publication Date
Sat Jun 01 2024
Journal Name
Progress In Color, Colorants And Coatings
The Potential of Gundelia Seeds Waste as an Emerging Sustainable Adsorbent for Methylene Blue-Polluted Water Treatment
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Gundelia, a genus of flowering plants native to the Mediterranean region, particularly in Iraq, holds promise as a sustainable adsorbent for the treatment of dye-polluted water. This study explores the potential of Gundelia seeds (GS) waste as a biobased adsorbent for removing methylene blue dye from synthesized wastewater. Utilizing various analytical techniques, including scanning electron microscopy (SEM), Fourier transform infrared (FTIR) spectroscopy, and X-ray diffraction analysis (XRD), we assessed GS as an active adsorbent with performance comparable to fabricated and expensive composites. Key parameters such as pH (3-11), pH at the point of zero charge, temperature (298-328 K), dose (0.02-0.1 g), dye concentration (10-50 ppm), and

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Publication Date
Tue Dec 11 2018
Journal Name
Journal Of Accounting And Financial Studies ( Jafs )
Contribution of Some Managerial Accounting Techniques to Achieve Market Share Requirements / Applied researchin the Al-Muthanna Cement Company
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The research aims to achieve market share requirements and reach the targeted competitive price through the application of management accounting techniques represented by continuous improvement technique and target costing under an Activity Based Cost (ABC) system and Activity Based Management (ABM), In Muthanna Cement Company to reach the rationalization of the cost of the product and maintain the required quality and improve the profitability of the company.

The problem of research has emerged in the inability of local firms to enter into effective competition with other companies operating in the same economic sector, Because of the high cost of its products, Which led to the sale of the product at prices below its cost, and t

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Publication Date
Mon Feb 01 2021
Journal Name
Engenharia Agrícola
HYPERSPECTRAL SPECTROSCOPY TO DETECT DIFFERENT RESPONSES OF TWO SOYBEAN (GLYCINE MAX) CULTIVARS TO CHARCOAL ROT (MACROPHOMINA PHASEOLINA) TOXIN
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Publication Date
Tue Mar 03 2026
Journal Name
Scr Med
Retrieval of Migrated Guidewire Extending From Right Ventricular Apex to the Inferior Vena Cava via Pigtail-Assisted Snaring
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Intravascular embolisation of foreign bodies (FB) is a rare, serious complication that may occur during central venous line insertion. A 39-yearold male in a critical condition presented to casualty department with a through-and-through chest gunshot wound. Chest X-ray showed left haemothorax; an urgent chest tube was introduced and central venous access was introduced via the right femoral vein. The guided wire used in the procedure was unintentionally pushed to reach the right ventricular apex. Echocardiography confirmed FB location. Once stabilised, the patient was referred to Iraqi Centre of Cardiac Diseases, where transcatheter retrieval was performed. To stabilise the FB, a 6F pigtail catheter was used to create a U-shaped loop in the

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Publication Date
Wed Feb 22 2023
Journal Name
Iraqi Journal Of Science
Test the Cytotoxicity of Pleurotin Extracted from an Edible Mushroom Pleurotus osteratus Against Three Human Carcinoma Cell Line
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The study included selection six species of the fungi related to Pleurotus genus were evaluated for their ability to production of Pleurotin, one of them, Pleurotus ostreatus (P.11) was isolated and identified in the present study. Pleurotin was extracted with screening by Thin Layer Chromatography (TLC) and quantification High Performance Liquid Chromatography (HPLC). Cytotoxicity of Pleurotin extracted from P. ostreatus (P.11) grown in different sugar sources (galactose, mannitol, sucrose, dextrose and lactose) liquid media was test against three selected cancer cell lines, CaSki, MCF-7 and A549 addition to Human Non Cancer Fibroblast Cell Line (MRC-5). Pleurotin of P. ostreatus (P.11) grown in galactose induced the significant highest

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