(988) Inpatient Use of FEIBA at an Academic Medical Center

Introduction: Anti-inhibitor Coagulant Complex (FEIBA) is FDA-approved for use in patients with hemophilia to either control or prevent bleeding, either as treatment, prophylaxis or in perioperative management. At the Medical University of South Carolina Health (MUSC), FEIBA is restricted for use in patients requiring treatment of severe anticoagulant-induced bleeding. The aim of this medication use evaluation was to understand our institutional inpatient use of FEIBA, assess adherence to institutional restriction guidelines, and evaluate if institutional policy should include pharmacist-to-bed involvement.

Methods: This was a single-center, retrospective cohort study evaluating all patients ≥ 18 years old who had at least one dose of FEIBA ordered between May 1, 2022, and April 30, 2023. Patient specific factors were collected along with complete blood counts, coagulation panels, blood product interventions made prior to FEIBA order entry, and time from order entry to verification and dose administration. Average wholesale prices were utilized in this analysis.

Results: Only 2 patients received FEIBA during the study period. Both patients were over 80 years old with a diagnosis of hemophilia requiring FEIBA for symptomatic anemia secondary to bleeding. Only one patient received packed red blood cells throughout the course of therapy. FEIBA was administered at a median dose of 48.7 IU/kg/dose (43.2 – 51.2 IU/kg/dose) with time from order entry to verification occurring in 2 minutes (0 – 35.8 min) and to first dose administration in 199 minutes (160 – 393 min). A total of 40 doses were prepared, one patient received 29 doses, the second received 3 doses, and 8 doses were wasted. All prepared doses cost $388,399. The median cost per dose was $11,524 ($10,093 – 12,954). The total cost of the 8 doses prepared but not administered amounted to $94,010.

Conclusions: FEIBA is a high-cost medication that is indicated for control and prevention of bleeding for patients with hemophilia. Overall, there is low utilization at our institution but there are prolonged times to administration, and significant cost from wasted doses. Future increased pharmacist involvement has the potential to reduce time to administration and ensure appropriate dose preparation, thus reducing overall cost.