Real World Experience with use of Coagulation Factor VIIa at an Academic Medical Center

BackgroundEptacog alfa and eptacog beta are recombinant factor VIIa (rFVIIa) agents approved for use in hemophilia A or B with inhibitors. Our institution converted from eptacog alfa to eptacog beta as the preferred rFVIIa product. The objective of this medication use evaluation was to review the utilization of both agents and cost savings associated with the conversion.MethodsWe performed a retrospective chart review for all eptacog alfa and beta administrations from October 2023 through September 2024. We evaluated product selection and dosing as well as the occurrence of thrombosis, new bleeding events, or existing bleeding that required therapy escalation. Cost savings were estimated using wholesale acquisition costs.ResultsThere were 17 patients that required 27 admissions for rFVIIa (eptacog alfa: 3, 11.1% and eptacog beta: 21, 77.8%). Three administrations (11.1%) utilized both agents. Indications included bleeding in hemophilia patients (12, 44.4%), followed by peri-procedural management (9, 33.3%), cardiac surgery (3, 11.1%), and anticoagulation reversal for life-threatening bleeding (3, 11.1%). There were 21 administrations in which eptacog beta was exclusively used (bleeding in hemophilia A (9, 33.3%), peri-procedural management (7, 25.9%), cardiac surgery (2, 7.4%), and anticoagulation reversal (3, 11.1%)). There were no thrombotic events. There were 5 patients (18.5%) who required rFVIIa dose escalation and two (7.4%) who required re-initiation of rFVIIa. Cost avoidance was estimated at $554,400 over a 12-month period.ConclusionWe treated a small cohort of patients with eptacog beta without adverse outcomes. Other hospitals might evaluate their rFVIIa use and consider opportunities for substitution.