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The most cost-effective treatment pathway for WSD patients was NASHA/Dx followed by SNS, with a maximum ICUR of 5,928 GBP/ QALY vs the other treatment pathways analysed. In comparison with treatment pathway excluding SNS, 0.55 QALY are gained. ConClusions: SNS is a relevant treatment for FI in patients who have failed conservative management. Including SNS into the treatment pathway for refractory FI may provide value-for-money in the UK NHS perspective.

Capsaicin 8% patch is cost-effective compared to pregabalin for patients who have failed one or more previous systemic treatments for PNP.Objectives: Multiple regimens are used in the treatment of severe haemophilia A in the Netherlands. Most patients receive clotting factors intravenously 2-3 times weekly to prevent bleedings: intermediate dose prophylaxis. Given the high utilization of prophylaxis treatment, budget restraints might hinder the availability of prophylaxis for patients in the nearby future. Other treatment regimens are ondemand (OD) treatment, administering clotting factors in case of bleedings, and prophylaxis treatment with a switch to OD at 18 years. This analysis estimates the cost-effectiveness of Dutch prophylaxis treatment for severe haemophilia A patients compared to other treatment regimens. MethOds: A Markov model is developed with the health stages 'Alive', 'Severe joint damage' and 'Death'. Bleeding rates of individual patients are simulated over lifetime, including a probability of inhibitor development. A higher joint bleed rate is accompanied by increased joint damage, increasing the chance of joint surgery. Disease progression, within the Alive health state, is modeled with the Pettersson Score (PS). The PS indicates the radiographic arthropathy. Increased joint damage is associated with physical limitations and decreased QoL. Because the chosen treatment regimen affects both the joint bleed rate and inhibitor development, it also affects the HRQoL. The analysis was performed from a societal perspective. Results: Prophylaxis treatment was associated with the greatest QoL. The cost-effectiveness acceptability curve shows a probability of 90% for prophylaxis treatment to be cost-effective at a threshold of € 0, -compared to OD treatment. Compared to prophylaxis with a switch to OD at 18 years, prophylaxis treatment has a 50% probability of being cost-effective at a € 80.000, -threshold. The model outcome is sensitive for variations in bleeding rate, prophylaxis dosage, inhibitor development and utilities. cOnclusiOns: Based on our model, treatment of severe haemophilia A patients with lifetime prophylaxis is cost-effective compared to OD treatment.

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