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Malaysian Statistics on MEDICINES-271010.Indd MALAYSIAN STATISTICS ON MEDICINES 2007 CHAPTER 7 | USE OF ANTIHAEMORRHAGICS Lim Y.S.1, Wong S.P.1, Goh A.S.2, Chang K.M.1 1. Ampang Hospital, 2. Pulau Pinang Hospital Antihaemorrhagics did not differ much in usage trends from 2006 to 2007. The most used class of antihaemorrhagics was still the class of amino acids, namely tranexamic acid (0.07 DDD/1000 population/day), owing to its safety profile, readily available forms as capsules and injection ampoules as well as cheap price. Tranexamic acid was used for local fibrinolysis and menorrhagia. The Australian data showed a higher consumption for tranexamic acid with 0.11 DDD/1000 population/day in 2007.1 Aprotinin, a proteinase inhibitor (0.0003 DDD/1000 population/ day), was indicated for the reduction or prevention of blood loss in patients undergoing open heart surgeries only.2 Aprotinin was apparently more used in the private sector than in the public sector as so happened in reality. Although recombinant Factor VIIa or eptacog alfa (activated) was one of the few agents available for haemophilia A or B patients with inhibitors to coagulation factors VIII or IX, recent years had seen it being used in excessive bleeding incidences unmanageable by conservative treatments or blood coagulation factors during minor or major surgical even critical neuro-surgical or obstetrics-gynaecological procedures.3 However, its overall usage was still very minimal at 0.0001 DDD/1000 population/day, perhaps due to its exorbitant price tag of ~RM 2700 per vial of 1.2mg. The length of stay in critically ill patients that need reversal of coagulopathy and the costs of hospitalisation should be added to the total charges that would count to the cost-effectiveness of eptacog alfa.4 In fact, eptacog alfa (activated) was little used in both sectors of the healthcare industry. This DDD was similar to its longer acting counterpart, Factor VIII inhibitor bypassing activity (FEIBA). This FEIBA had hardly any usage reported in 2006, being relatively new in the market and minimally used in both sectors in 2007. The blood coagulation factors VII, Von Willebrand Factor Concentrate, and FEIBA, as well as Factor IX concentrate, were not used in private sector in both years 2006 and 2007 while recording a low DDD in the public sector. The World Federation of Haemophilia (WFH) estimated the prevalence of Haemophilia A of developing countries as a mean 6.6 SD 4.8 per 100,000 males in 2004.5 For the severe forms of haemophilia, treatment was required regularly and throughout the patients’ entire lifetime, to avoid target joints damage, deformity, disability or even early death. Factor concentrates are normally given as on-demand basis, as opposed to primary or secondary prophylaxis in the West. Without insurance coverage due to its nature as a congenital disease, apparently haemophilia patients largely obtain factor concentrates from the public hospitals at no cost. There was little difference between the year 2006 and 2007 in the usage of coagulation factor concentrates. Table 7.1: Use of Antihaemorrhagics, in DDD/1000 population/day 2006-2007 ATC Drug Class 2006 2007 B02 Antihaemorrhagics 0.0720 0.0697 Table 7.2.1: Use of Antihaemorrhagics by Drug Class, in DDD/1000 population/day 2006-2007 ATC Drug Class 2006 2007 B02A Antifibrinolytics 0.0702 0.0681 B02A A Amino acids 0.0695 0.0678 B02A B Proteinase inhibitors 0.0006 0.0003 B02B Vitamin K and other haemostatics 0.0018 0.0016 B02B D Blood coagulation factors 0.0018 0.0016 26 27 MALAYSIAN STATISTICS ON MEDICINES 2007 CHAPTER 7 | USE OF ANTIHAEMORRHAGICS Table 7.2.2 : Use of Antihaemorrhagics by Drug Class and Agents, in DDD/1000 population/day 2006-2007 ATC Drug Class and Agents Sector 2006 2007 B02A A Amino acids Public 0.0524 0.0535 B02A A02 Tranexamic acid Private 0.0172 0.0143 Total 0.0695 0.0678 Public - - B02A A03 Aminomethylbenzoic acid Private - - Total - - B02A B Proteinase inhibitors Public <0.0001 0.0001 B02A B01 Aprotinin Private 0.0006 0.0002 Total 0.0006 0.0003 B02B D Blood coagulation factors Public 0.0007 0.0006 B02B D02 Coagulation factor VIII Private <0.0001 <0.0001 Total 0.0007 0.0006 Public - <0.0001 B02B D03 Factor VIII inhibitor bypassing activity Private - - Total - <0.0001 Public 0.0011 0.0008 B02B D04 Coagulation factor IX Private - - Total 0.0011 0.0008 Public - 0.0001 B02B D05 Coagulation factor VII Private - - Total - 0.0001 Public - <0.0001 B02B D06 Von Willebrand factor and coagulation factor VIII in combination Private - - Total - <0.0001 Public <0.0001 <0.0001 B02B D08 Eptacog alfa (activated) Private <0.0001 <0.0001 Total <0.0001 <0.0001 References: 1. Stonebraker J.S., Amand R.E., Nagle A.J. A country-by-country comparison of FVIII concentrate consumption and economic capacity for the global haemophilia community Haemophilia 2003; 9 (3): 245-250 2. British National Formulary September 2006 3. Ampaiwan Chuansumrit, Pantep Angchaisuksiri, Nongnuch Sirachainan. Critical appraisal of the role of recombinant activated factor VII in the treatment of haemophilia patients with inhibitors Journal of Blood Medicine REVIEW March 2010 4. Lyseng-Williamson K.A., Plosker G.L. Recombinant Factor VIIa (Eptacog alfa): A pharmacoeconomic review of its use in haemophilia in patients with inhibitors to clotting factors VIII and IX. Pharmacoeconomics 2007; 25: 1007-1029 5. Stonebraker J.S., Bolton-Maggs P.H.B., Soucie J.M., Walker I., Brooker M. A study of variations in the reported haemophilia A prevalence around the world. Haemophilia 2010; 16: 20-32 28 29.
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