Reply to “Key Points to Consider When Evaluating Andexxa for Formulary Addition”

Mahan, Charles E.

doi:10.1007/s12028-020-01008-z

Cited by 1 publication

(4 citation statements)

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“…Cost for PCC (Kcentra-4-PCC) for an adult patient is approximately $3200 (2000 units-average as dosage), while the cost for andexanet alfa can reach $49 500 for high dose and $27 500 for low-dose therapy. 7 Cuker et al 22 noted guidance from expert opinion consensus bodies, such as the North American Anticoagulation Forum, suggest andexanet alfa poses a notable financial challenge for hospitals. Hospitals can alleviate cost burden by obtaining direct oral factor Xa antagonist reversal agents on consignment through vendors, keeping a limited number of doses on hand based on anticipated need.…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…Additionally, Mahan 7 identified key points to consider when evaluating Andexxa for formulary addition summarizing considerations and evidence regarding the use of 4F-PCC and Andexxa for direct oral factor Xa antagonist reversal. 7 They compared efficacy, adverse events, and costs. Recommendations from Witt et al 11 (American Society of Hematology), Tomaselli et al 12 (American College of Cardiology), and Lip et al 13 (American College of Chest Physicians) were compared.…”

Section: Introductionmentioning

confidence: 99%

“… 13 The conclusion was a judicious assessment based on consensus statements and observational or single-arm studies, not based on head-to-head comparison. 7 Rodriguez et al 14 published in Clinical and Applied Thrombosis/Hemostasis in 2022 a survey of pediatric hematologists comparing Andexxa and PCC use for reversal of direct oral factor Xa antagonists, with the results equally divided. 14 …”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Use of Andexanet Alfa for Factor Xa Inhibitor Reversal in US Verified Trauma Centers: A National Survey

Fasanya,

Arrillaga,

Caronia

et al. 2024

Clin Appl Thromb Hemost

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Direct oral factor Xa inhibitors are replacing vitamin K-dependent antagonists as anticoagulation treatment in many clinical scenarios. Trauma centers are noting an increase in patients presenting on these medications. The 2018 Food and Drug Administration approval of andexanet alfa provides an alternative anticoagulation reversal. Barriers may limit utilization of new medications including a lack of grade 1A evidence supporting the use of prothrombin complex concentrate (PCC) versus andexanet alfa and cost. To evaluate barriers of andexanet alfa utilization by trauma surgeons, a 15-question survey was conducted. There was a 9% completion rate (n = 89). The results revealed 23.5% would choose andexanet alfa as first-line treatment in children, and 25.8% as first-line treatment in adults. The majority of respondents, 64.7% and 67.4%, would use PCC preferentially in children and adults, respectively. Respondents indicated that cost burden was an overriding factor (76.3%); 42.4% cited lack of high-level efficacy data of andexanet alfa for reversal of factor Xa inhibitors. Additional double-blinded multi-institutional randomized controlled trials comparing 4F-PCC and andexanet alfa for factor Xa inhibitor reversal are needed to support efficacy especially with the increased cost associated.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%