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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 04 2023
Journal Name
Al-rafidain Journal Of Medical Sciences ( Issn 2789-3219 )
Factors Influencing Adalimumab Treatment Response in Patients with Rheumatoid Arthritis: The Future of Clinical Expertise
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Rheumatoid arthritis (RA) is characterized by persistent joint inflammation, which is a defining feature of this chronic inflammatory condition. Considerable advancements have been made in the field of disease-modifying anti-rheumatic medicines (DMARDs), which effectively mitigate inflammation and forestall further joint deterioration. Anti-tumor necrosis factor-alpha (TNF-α) drugs, which are a class of biological DMARDs (bDMARDs), have been efficaciously employed in the treatment of RA in recent times Adalimumab, a TNF inhibitor, has demonstrated significant efficacy in reducing disease symptoms and halting disease progression in patients with RA. However, its use is associated with major side effects and high costs. In addition,

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Publication Date
Thu Jun 01 2023
Journal Name
Medicinal Chemistry
New Niflumic Acid Derivatives as EGFR Inhibitors: Design, Synthesis, In silico Studies, and Anti-proliferative Assessment
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Background:

1,3,4-oxadizole and pyrazole derivatives are very important scaffolds for medicinal chemistry. A literature survey revealed that they possess a wide spectrum of biological activities including anti-inflammatory and antitumor effects.

Objectives:

To describe the synthesis and evaluation of two classes of new niflumic acid (NF) derivatives, the 1,3,4-oxadizole derivatives (compounds 3 and (4A-E) and pyrazole derivatives (compounds 5 and 6), as EGFR tyrosine kinase inhibitors in silico and in vitro.

Methods:

The designed compounds were synthesized using convent

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Publication Date
Wed Mar 01 2023
Journal Name
Al-khwarizmi Engineering Journal
Expired Colxacillin, Amoxicillin, and Ceflaxin Drugs as Inhibitors for Low Carbon Steel Corrosion in Sodium Chloride
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The ability to inhibit corrosion of low carbon steel in a salt solution (3.5%NaCl) has been checked with three real expired drugs (Cloxacillin, Amoxicillin, Ceflaxin) with variable concentrations (0, 250, 500, 750) mg/L were examined in the weight loss. The inhibition efficiency of the Cloxacillin 750 mg/L showed the highest value (82.8125 %) and the best inhibitor of the rest of the antibiotics. The different concentrations of Cloxacillin drug (0, 250, 500, 750) mg/L and temperature (25, 35, 45, 55) oC were studied as variables with potentiodynamic polarization, Scanning Electron Microscopy (SEM) for surface morphology and electrochemical impedance spectroscopy (EIS) depending on current values and the resistance of charge to

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Publication Date
Fri Oct 07 2022
Journal Name
Texas Journal Of Engineering And Technology
Estimation of Pore Pressure and In-Situ Stresses for Halfaya Oil Field: A Case Study
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Publication Date
Fri Dec 01 2017
Journal Name
Journal Of Accounting And Financial Studies ( Jafs )
Tax Exemptions and their impact in reducing the phenomenon of tax evasion: A field study
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The research aims to verifying the tax exemptions granted in accordance with the Iraqi tax legislations, showing their suitability for basic tax rules, and identifying their role to reduce the tax evasion phenomenon and the negative effects resulting therefrom, which arerepresented by a decrease in the proceeds of tax revenue and therefore leadings to a reduction of public revenues of the state. Also, the research tries to identify the ways to reduce cases of tax evasion due to their reflection positively on the public budgetof the state. The data of the research was collected through two models of questionnaires distributed to a sample of taxpayers from some professions and a sample of the tax administration staff. The research has reac

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Publication Date
Sun Dec 22 2019
Journal Name
Iraqi Journal Of Pharmaceutical Sciences ( P-issn 1683 - 3597 E-issn 2521 - 3512)
Assessment of Causality, Severity and Seriousness of Adverse Event Following Immunization in Iraq: A Retrospective Study Based on Iraqi
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Immunization is one of the most cost-effective and successful public health applications. The results of immunization are difficult to see as the incidence of disease occurrence is low while adverse effects following the immunization are noticeable, particularly if the vaccine was given to apparently healthy person. High safety expectations of population regarding the vaccines so they are more prone to hesitancy regarding presence of even small risk of adverse events which may lead to loss of pub

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Publication Date
Wed Jan 30 2013
Journal Name
Al-kindy College Medical Journal
Regeneration of Pain, Touch, Cold, and Warmth, sensations in split thickness human skin grafts in adults (A clinical study)
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Back ground: Skin grafting is the most common form
of reconstructive surgery, and regeneration of
sensations in skin grafts is a complex process
influenced by many factors such as , the thickness of
the graft, the depth of the grafted bed, meshing of the
graft, the condition of the bed and the surrounding
area. So many studies performed on this subject, some
of them clinically based on subjective type of sensation
tests, and others histological to detect the presence of
nerve fibers in the grafted skin
Objectives: To detect return of sensations to split
thickness skin grafts by clinical methods.
Methods: From Oct. 1995 to Oct. 2010, a clinical
prospective study performed in Al wasity Hospital for

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Publication Date
Sat Apr 09 2022
Journal Name
Engineering, Technology &amp; Applied Science Research
A Semi-Empirical Equation based on the Strut-and-Tie Model for the Shear Strength Prediction of Deep Beams with Multiple Large Web Openings
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The behavior and shear strength of full-scale (T-section) reinforced concrete deep beams, designed according to the strut-and-tie approach of ACI Code-19 specifications, with various large web openings were investigated in this paper. A total of 7 deep beam specimens with identical shear span-to-depth ratios have been tested under mid-span concentrated load applied monotonically until beam failure. The main variables studied were the effects of width and depth of the web openings on deep beam performance. Experimental data results were calibrated with the strut-and-tie approach, adopted by ACI 318-19 code for the design of deep beams. The provided strut-and-tie design model in ACI 318-19 code provision was assessed and found to be u

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Publication Date
Wed Apr 22 2026
Journal Name
Environmental Earth Sciences
Transboundary hydrogeology and controlling factors of euphrates water chemistry: Insights from hydrochemistry, stable isotopes, and residence times in Syria and Western Iraq
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Arid and semi-arid climates are critical for water security in sustainable river systems. The Euphrates River in western Iraq has been increasingly stressed by both geogenic and anthropogenic factors. This study analyzed hydro-geochemical processes, recharge dynamics, and groundwater flow modeling in western Iraq. Additionally, stable isotope tracing (δ¹⁸O, Cl⁻) integrated with hydro-chemical parameters was used to assess water quality and river-aquifer connectivity in both Syria and western Iraq. A total of 144 groundwater samples were collected annually across 12 stations in western Iraq. Surface water and groundwater data were collected from previous studies at 13 stations in Syria. Results revealed slightly alkaline freshwater con

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Publication Date
Tue Feb 05 2019
Journal Name
Journal Of The College Of Education For Women
The effectiveness of internal rhythm in the poetry of Ridicule with Ibin Bassam al-Bagdadi
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This study seeks to uncover the aesthetics of the internal rhythm and its effectiveness in
enriching the poetic text with the music tone at represented in the art of repetition and the
permit and recycling division and put back on the chest and the naturalization interview and
counterpoint.
And try to stand on the impact of internal rhythm to highlight the meaning of spelling and
irony with poet Ibn Bassam Al-Bagdadi and have a close look at the literary and
psychological motivations that led the poet to employ these colors in his ridicule and the
extent of its contribution to intensify the poetic alphabetic flush.
And deepening the meanings and provide poetic text in different aesthetics, there is no doubt
tha

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