The First Discrete Choice Experiment On Usage of Bypassing Agents in Hemophilic Patients in Iran

Background: Bleeding events in hemophilic patients with inhibitors are managed by bypassing agents. Currently available agents in Iran are recombinant activated factor VII (rfVIIa; Aryogen, Aryoseven) and Feiba (factor eight inhibitor bypassing agent). No standardized and accurate assay is currently available for monitoring the effectiveness of bypassing agents. We suggested that history of the patients’ response and also their preference could be a reliable method for assessing the efficacy of bypassing agents; therefore, we designed a multi-centric discrete choice experiment study to assess the factors that affect the efficacy of bypassing agents. Methods: Hemophilic patients older than 2 years with inhibitors who required bypassing agents for the treatment of bleeding episodes were eligible to participate in the study. Patients’ preference toward treatment with either Feiba or Aryoseven was measured with a DCE (discrete choice experiment) design on a phone interview. Results: 80 patients were enrolled from 5 centers in Iran. At enrollment, the mean age was18.6 years (range, 2-50 years). 47 patients (58%) preferred to receive FEIBA, 21 patients (21.2%) favored Aryoseven and 12 (14.8%) patients claimed no difference between the two products. Conclusion: Our results indicated that according to the DCE method, patients preferred Feiba to Aryoseven while the main reason was their higher efficacy. In addition, adverse reactions in both groups were almost equal. As a result, it seems that presence of both products in the market for hemophilic patients with inhibitors is absolutely essential.