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Peral C, De Lossada Juste A, Lwoff N, Espinoza-Cámac N, Casado MÁ, Burke T, Alvir J, Thakkar S, Ferri Grazzi E. Economic and Humanistic Burden of Moderate and Severe Hemophilia A and B in Spain: Real-World Evidence Insights from the CHESS II Study. JOURNAL OF HEALTH ECONOMICS AND OUTCOMES RESEARCH 2024; 11:122-133. [PMID: 38721331 PMCID: PMC11078526 DOI: 10.36469/001c.92369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 01/16/2024] [Indexed: 09/16/2024]
Abstract
Background: Hemophilia is a congenital disorder characterized by deficiency or absence of clotting factor VIII in hemophilia A (HA) or clotting factor IX in hemophilia B (HB), resulting in frequent, repeated, and prolonged spontaneous or traumatic bleeding into joints or soft tissue. Severity is classified by the patient's baseline level of clotting factor activity as mild (>5%-40%), moderate (1%-5%), or severe (<1%). In Spain, there is limited information on the societal economic burden of disease. Objective: To estimate the economic and humanistic burden of disease in adult patients with non-inhibitor moderate and severe HA and HB in Spain. Methods: Spanish data from the CHESS II study (2018-2020) on patients' clinical characteristics, health-related quality of life (HRQoL) and hemophilia-related healthcare resource utilization were analyzed. Economic burden was determined by estimating condition-related annual per-patient direct (medical and nonmedical) and indirect costs, stratified according to hemophilia type and severity and presented as 2022 Euros. HRQoL was assessed via the EQ-5D-5L. Results: Of 341 patients in the Spanish CHESS II cohort, 288 patients met the inclusion criteria: 181 had HA (37% [n = 66] moderate and 63% [n=115] severe) and 107 had HB (26% [n = 28] moderate and 74% [n = 79] severe). Mean annual direct cost was higher in HB than in HA, and higher in severe than in moderate patients, resulting in an annual cost/patient of €17 251 (moderate HA), €17 796 (moderate HB), €116 767 (severe HA) and €206 996 (severe HB). The main direct cost component in all groups except moderate HA was factor replacement therapy. Mean per-patient indirect cost was €4089 (moderate HA), €797 (moderate HB), €8633 (severe HA) and €8049 (severe HB). Finally, the mean total cost (direct and indirect) for moderate and severe patients were €91 017 (HA) and €163 924 (HB). EQ-5D-5L [SD] scores were lower in patients with severe HA (0.77 [0.18]) and severe HB (0.70 [0.22]) compared with patients with moderate HA (0.81 [0.15]) and moderate HB (0.86 [0.17]). Conclusions: Independently of the type of hemophilia, greater condition severity was associated with increased costs and a decrease in HRQoL.
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Affiliation(s)
| | | | | | | | | | - Tom Burke
- HCD Economics, Daresbury, UK
- Faculty of Health and Social Care University of Chester, Chester, UK
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Chiari JB, Prozora S, Feinn R, Louizos E, Gallagher PG, Bona R. Joint bleeds in mild hemophilia: Prevalence and clinical characteristics. Haemophilia 2024; 30:331-335. [PMID: 38240020 DOI: 10.1111/hae.14939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 12/12/2023] [Accepted: 01/05/2024] [Indexed: 03/14/2024]
Abstract
INTRODUCTION Joint bleeds are a common and frequent complication associated with hemophilia, increasing the risk of hemophilic arthropathy. It is important to define and characterize the presence of joint complications in mild hemophilia to develop strategies to mitigate disease burden. AIMS To characterize the prevalence, clinical characteristics of joint bleeds, and risk factors that may lead to hemarthrosis in people with mild hemophilia. METHODS Following Institutional Review Board approval, a retrospective chart review was conducted for patients with mild hemophilia seen at the Yale Hemophilia Treatment Center or Classical Hematology Program. RESULTS The medical records of 70 patients were reviewed. Eighty one percent were male and 19 percent were female. Twenty individuals with mild hemophilia had a history of joint bleeding, 13 were traumatic bleeds, 7 were spontaneous. The age of first joint bleed ranged from 4 to 58 years old, with an average age of 20.8-years old. Ten patients developed joint bleeds between the ages of 10 and 20 years old. The most common locations of joint bleeding were the knee (n = 11) and ankle (n = 7). Eight of 70 patients had hepatitis C (HCV), 6 experienced joint bleeding. CONCLUSIONS In this study, almost one third of patients with mild hemophilia experienced joint bleeding, often without history of trauma. Joint range of motion was abnormal in more than a third of the patients with mild hemophilia regardless. These data highlight the need for ongoing evaluation and characterization of joint health in individuals with mild hemophilia. HIGHLIGHTS Twenty-nine percent of individuals with mild hemophilia had history of joint bleed. PwH and mild diseases with previous or current hepatitis C had higher likelihood of joint bleeding. Approximately 15% of PwH and mild diseases had abnormal joint examinations without a confirmed history of joint bleeding.
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Affiliation(s)
- John B Chiari
- Department of Surgery, Memorial Health University Medical Center, Savannah, Georgia, USA
| | - Stephanie Prozora
- Department of Pediatrics, Hemophilia Treatment Center, Yale School of Medicine, New Haven, Connecticut, USA
| | - Richard Feinn
- Frank H. Netter School of Medicine, Department of Medical Sciences, Quinnipiac University, North Haven, Connecticut, USA
| | - Evangelia Louizos
- Department of Pediatrics, Hemophilia Treatment Center, Yale School of Medicine, New Haven, Connecticut, USA
| | - Patrick G Gallagher
- Wexner Research Institute at Nationwide Children's Hospital, Department of Pediatrics, Ohio State University, Columbus, Ohio, USA
| | - Robert Bona
- Department of Medicine, Hemophilia Treatment Center, Yale School of Medicine, New Haven, Connecticut, USA
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Montoro-Ronsano JB, Poveda-Andrés JL, Romero-Garrido JA, García-Barcenilla S, González-Álvarez I, Núñez-Vázquez R, Rambla-Pérez M, Soto-Ortega I. [Translated article] Consensus recommendations for the improvement of inter- and intra-centre care coordination in the management of hemophilia. FARMACIA HOSPITALARIA 2023; 47:T100-T105. [PMID: 37150664 DOI: 10.1016/j.farma.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 01/05/2023] [Accepted: 01/06/2023] [Indexed: 05/09/2023] Open
Abstract
OBJECTIVE Define consensus recommendations to improve care coordination between Hospital Pharmacy, Hematology and Nursing, inter- and intra-center, in the care of hemophilia patients. METHOD Recommendations for the improvement of care coordination in the management of hemophilia patients were identified and assessed by a multidisciplinary panel of professionals with experience in this field (Hospital Pharmacy, Hematology and Nursing) and supported by scientific evidence. The identified recommendations were assessed by Rand/UCLA consensus methodology (Delphi-adapted) based on their appropriateness and, subsequently, on their necessity. In both cases, it was used ordinal Likert scale. Data were statistically analyzed through different metrics. RESULTS Fifty-three recommendations for the improvement of care coordination between Hospital Pharmacy, Hematology and Nursing in the management of hemophilia patients were identified, grouped into eight areas of action: i) Hemophilia units, reference centers and multidisciplinary care; ii) Role of Hematology, Hospital Pharmacy and Nursing in the patient journey of hemophilia patients; iii) Telepharmacy and telemedicine; iv) Pharmacokinetic monitoring; v) Transition to adult patient regimen; vi) Patient health education; vii) Surgery, emergency room and hospital admission; and viii) Outcome evaluation. All recommendations were assessed as appropriate and necessary by the external expert panel. CONCLUSIONS Hemophilia patient journey is complex and depends on different variables. It also requires the involvement of different healthcare professionals who must act in a coordinated and integrated manner at all stages of the patient's life, adapted to their individual needs. On this matter, the identified and agreed recommendations may improve continuity and quality of care, as they facilitate the integration and coordination of the professionals involved in the management of this pathology, especially Hospital Pharmacy, Hematology and Nursing.
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Affiliation(s)
| | - José Luis Poveda-Andrés
- Servicio de Farmacia Hospitalaria, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | | | - Sara García-Barcenilla
- Unidad de Coagulopatías Congénitas y Adquiridas, Instituto de Investigación Hospital Universitario La Paz, IdiPAZ, Comunidad de Madrid, Spain
| | - Iria González-Álvarez
- Unidad de Hematología Clínica, Hospital de la Santa Creu i Sant Pau, Barcelona, Comunidad de Madrid, Spain
| | - Ramiro Núñez-Vázquez
- Sección de Trombosis y Hemostasia, Servicio de Hematología, Unidad de Gestión Clínica de Hematología del Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | | | - Inmaculada Soto-Ortega
- Sección de Hemostasia y Trombosis, Servicio de Hematología y Hemoterapia, Hospital Universitario Central de Asturias (HUCA), Laboratorio de Investigación en Plaquetas, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
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Montoro-Ronsano JB, Poveda-Andrés JL, Romero-Garrido JA, García-Barcenilla S, González-Álvarez I, Núñez-Vázquez R, Rambla-Pérez M, Soto-Ortega I. Consensus recommendations for the improvement of inter- and intra-centre care coordination in the management of hemophilia. FARMACIA HOSPITALARIA 2023; 47:100-105. [PMID: 36764844 DOI: 10.1016/j.farma.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 01/05/2023] [Accepted: 01/06/2023] [Indexed: 02/12/2023] Open
Abstract
OBJECTIVE Define consensus recommendations to improve care coordination between Hospital Pharmacy, Haematology and Nursing, inter- and intra-center, in the care of haemophilia patients. METHOD Recommendations for the improvement of care coordination in the management of haemophilia patients were identified and assessed by a multidisciplinary panel of professionals with experience in this field (Hospital Pharmacy, Haematology and Nursing) and supported by scientific evidence. The identified recommendations were assessed by Rand/UCLA consensus methodology (Delphi-adapted) based on their appropriateness and, subsequently, on their necessity. In both cases, it was used ordinal Likert scale. Data were statistically analysed through different metrics. RESULTS Fifty-three recommendations for the improvement of care coordination between Hospital Pharmacy, Haematology and Nursing in the management of haemophilia patients were identified, grouped into eight areas of action: i) Haemophilia units, reference centers and multidisciplinary care; ii) Role of Haematology, Hospital Pharmacy and Nursing in the patient journey of haemophilia patients; iii) Telepharmacy and telemedicine; iv) Pharmacokinetic monitoring; v) Transition to adult patient regimen; vi) Patient health education; vii) Surgery, emergency room and hospital admission; and viii) Outcome evaluation. All recommendations were assessed as appropriate and necessary by the external expert panel. CONCLUSIONS Haemophilia patient journey is complex and depends on different variables. It also requires the involvement of different healthcare professionals who must act in a coordinated and integrated manner at all stages of the patient's life, adapted to their individual needs. On this matter, the identified and agreed recommendations may improve continuity and quality of care, as they facilitate the integration and coordination of the professionals involved in the management of this pathology, especially Hospital Pharmacy, Haematology and Nursing.
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Affiliation(s)
| | - José Luis Poveda-Andrés
- Servicio de Farmacia Hospitalaria, Hospital Universitario y Politécnico La Fe, Valencia, España
| | | | - Sara García-Barcenilla
- Unidad de Coagulopatías Congénitas y Adquiridas, Instituto de Investigación Hospital Universitario La Paz, Madrid, España
| | - Iria González-Álvarez
- Unidad de Hematología Clínica, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - Ramiro Núñez-Vázquez
- Sección de Trombosis y Hemostasia, Servicio de Hematología, Unidad de Gestión Clínica de Hematología del Hospital Universitario Virgen del Rocío, Sevilla, España
| | | | - Inmaculada Soto-Ortega
- Sección de Hemostasia y Trombosis, Servicio de Hematología y Hemoterapia, Hospital Universitario Central de Asturias, Oviedo, España; Laboratorio de Investigación en Plaquetas, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, España
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Schnohr C, Ekholm O, Poulsen LH, Lehrmann L, Andersen T, Funding E, Holm KB, Bjorner JB. Health and quality of life of patients with haemophilia: A national study of 124 Danish men. Haemophilia 2023; 29:538-544. [PMID: 36729615 DOI: 10.1111/hae.14751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 01/17/2023] [Accepted: 01/18/2023] [Indexed: 02/03/2023]
Abstract
PURPOSE In the past decades, haemophilia treatment has greatly improved the health of persons with haemophilia (PWH). This study compares PWH to the general population on social conditions and health. METHODS In December 2021, all Danes with moderate or severe haemophilia A or B, or von Willebrands disease type 3 were invited to participate in an online self-report survey concerning sociodemographic factors, self-rated health, teeth status, chronic health conditions, symptoms and loneliness. This study compares responses from the 124 adult male PWH with responses from a male general population sample (N = 4849). Analyses used logistic regression, controlling for age and highest completed education. RESULTS Fewer PWH were in the oldest age group (65-84 years). Controlling for age, no significant differences were found regarding cohabitation status or education. Fewer PWH were employed (OR = .48, [.33-.71])-particularly in the 45-64 age group. PWH were less likely to report good health (OR = .49, [.31-.77]). The odds of joint disease was much higher (OR = 13.00, [8.37-20.28]). Also, hypertension (OR = 2.25, [1.13-5.65]) and previous stroke (OR = 2.51, [1.44-3.50]) were more frequent. PWH were more likely to report pain in the arms/hands/legs/hips (OR = 2.94, [1.92-4.52]), but less likely to report pain in the head/neck/shoulder (OR = .66, [.45-.96]). CONCLUSION The disease burden of haemophilia has improved so PWH resembles the general population in areas such as marriage and education. However, even for young PWH, the disease still imposes a significant burden from hemophilia arthropathy and pain in extremities and joints. Middle-aged PWH also have poorer levels of employment than same-aged peers.
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Affiliation(s)
- Christina Schnohr
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Ola Ekholm
- National Institute of Public Health, Copenhagen, Denmark
| | | | | | | | - Eva Funding
- Department of Haematology, Rigshospitalet, Copenhagen, Denmark.,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | - Jakob Bue Bjorner
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Blazquez-Ramos N, Romero-Garrido JA, Gonzalez Del Valle L, Collada-Sanchez VL, Alvarez-Roman MT, Jimenez-Yuste V, Martin-Salces M, De la Corte-Rodriguez H, Herrero-Ambrosio A, Benedi-Gonzalez J, Rodriguez-Merchan EC. Development of a telematic pharmaceutical care app (Haemoassist) for multidisciplinary follow-up of patients with congenital coagulopathies. Expert Rev Hematol 2023; 16:213-226. [PMID: 36563352 DOI: 10.1080/17474086.2023.2162497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Guidelines for congenital coagulopathies recommend that patients record treatment administrations and bleeding episodes to help healthcare professionals monitor the disease. RESEARCH DESIGN AND METHODS We studied over two years which patient profiles (age, treatment regimen, treatment compliance) were most likely to accept the use of an app to collect this information. We validated the quality of patient-reported data by comparing it with data obtained from hospital electronic records, pharmacy dispensing records and patient interview, collected in an access database used as a reference. Patient and professional opinions were solicited through open-ended interviews. RESULTS The app was used by 52% of 315 patients studied. Younger patients were the most frequent users. Patients with better treatment compliance used the app more, although data collection was incomplete for most patients. The best rated by patients were the reminders of days of administration and the minimum stock alerts at home. Healthcare professionals rated the app positively. CONCLUSIONS Healthcare professionals valued the app as useful for managing treatment of congenital coagulopathies. Patients need support and time to use the app and improve the quality of the data entered. Patients who used the app rated it positively. The treatment compliance improved.
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Affiliation(s)
- Nuria Blazquez-Ramos
- Department of Pharmacy, La Paz University Hospital, Madrid, Spain.,IdiPAZ, La Paz University Hospital Health Research Institute, Madrid, Spain
| | - José A Romero-Garrido
- Department of Pharmacy, La Paz University Hospital, Madrid, Spain.,IdiPAZ, La Paz University Hospital Health Research Institute, Madrid, Spain.,Department of Pharmacology, Complutense University of Madrid, Madrid, Spain
| | - Luis Gonzalez Del Valle
- Department of Pharmacy, La Paz University Hospital, Madrid, Spain.,IdiPAZ, La Paz University Hospital Health Research Institute, Madrid, Spain
| | | | - María Teresa Alvarez-Roman
- IdiPAZ, La Paz University Hospital Health Research Institute, Madrid, Spain.,Department of Hematology, La Paz University Hospital, Madrid, Spain
| | - Victor Jimenez-Yuste
- IdiPAZ, La Paz University Hospital Health Research Institute, Madrid, Spain.,Department of Hematology, La Paz University Hospital, Madrid, Spain
| | - Monica Martin-Salces
- IdiPAZ, La Paz University Hospital Health Research Institute, Madrid, Spain.,Department of Hematology, La Paz University Hospital, Madrid, Spain
| | - Hortensia De la Corte-Rodriguez
- IdiPAZ, La Paz University Hospital Health Research Institute, Madrid, Spain.,Department of Physical Medicine and Rehabilitation, La Paz University Hospital, Madrid, Spain
| | - Alicia Herrero-Ambrosio
- Department of Pharmacy, La Paz University Hospital, Madrid, Spain.,IdiPAZ, La Paz University Hospital Health Research Institute, Madrid, Spain
| | | | - E Carlos Rodriguez-Merchan
- IdiPAZ, La Paz University Hospital Health Research Institute, Madrid, Spain.,Department of Orthopedic Surgery, La Paz University Hospital, Madrid, Spain
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Soto I, Mateo J, García-Diego DA, Gil B, Ruiz-Beato E, Ivanova Y, Martín Lorenzo T, Maravilla-Herrera P, Hidalgo-Vega Á, Merino M. The impact of improving haemophilia A management within the Spanish National Healthcare System: a social return on investment analysis. BMC Health Serv Res 2022; 22:115. [PMID: 35081958 PMCID: PMC8793183 DOI: 10.1186/s12913-021-07447-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 12/22/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Haemophilia A (HA) has been associated with poor health-related quality of life and a large economic burden, accentuated by severity, arthropathy, and inhibitors. To meet global standards of care, the management of HA should align with the principles of care outlined by the World Federation of Haemophilia. The aims of the present study were to establish a set of proposals to improve HA management within the Spanish National Health System (SNHS) and to estimate the impact its hypothetical implementation would generate from a clinical, healthcare, economic, and social perspective. METHODS A multidisciplinary group of experts agreed on a set of 15 proposals to improve HA management within the SNHS. Thereafter, a forecast-type Social Return on Investment analysis was carried out to estimate the impact of implementing this set of proposals within the SNHS over a one-year timeframe, in relation to the required investment. RESULTS This study estimated that the implementation of the complete set of 15 proposals would require a total investment of 2.34 M€ and have a total impact of 14.60 M€. Accordingly, every euro invested in the complete set of 15 proposals would yield a social return of €6.23 (€3.37 in the worst-case scenario and €9.69 in the best-case scenario) of both tangible and intangible nature in similar proportions (45.71 and 54.29%, respectively). CONCLUSIONS These results can be used to inform policy and practice such that interventions that may potentially improve current public health challenges associated with the management of HA may be implemented.
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Affiliation(s)
| | - José Mateo
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | | | | | - Yoana Ivanova
- Weber, Calle Moreto, 17, 5 Dcha, 28014 Madrid, Spain
| | | | | | | | - María Merino
- Weber, Calle Moreto, 17, 5 Dcha, 28014 Madrid, Spain
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Ucero-Lozano R, López-Pina JA, Ortiz-Pérez A, Cuesta-Barriuso R. Quality of life and its predictors among adult patients with haemophilic arthropathy. An observational study. BMC Musculoskelet Disord 2021; 22:448. [PMID: 33992116 PMCID: PMC8126122 DOI: 10.1186/s12891-021-04319-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 05/05/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Recurrent hemarthrosis that begin in childhood lead to progressive joint deterioration. Patients with haemophilia have chronic pain, functional disability and a reduced perception of health-related quality of life. PURPOSE To analyse the perceived quality of life of adult patients with haemophilic arthropathy and its relationship with pain, joint condition, kinesiophobia and catastrophism. METHODS Eighty-three adult patients with haemophilia were included in this multicentre, cross-sectional, descriptive study. Perceived quality of life (36-Item Short Form Health Survey), perceived usual and maximum pain (visual analogue scale), joint condition (Haemophilia Joint Health Score), kinesiophobia (Tampa Scale of Kinesiophobia) and catastrophism (Pain Catastrophizing Scale) were assessed. Sociodemographic, clinical and therapeutic variables and drug consumption for pain control were collected. Descriptive statistics used means and standard deviations. The correlation of quality of life with the dependent variables was calculated with the Pearson correlation test. The differences in quality of life as a function of the binomial variables were calculated with Student's t-test for independent samples. RESULTS Physical component of quality of life perceived by patients with hemophilia is lower than Spanish population (30.51 VS 48.85). Regarding the mental component, patients with hemophilia showed higher values (56.07 VS 49.97). Catastrophism correlated (p < .05) with all items of quality of life questionnaire. Kinesiophobia correlated (p < .05) with all items of quality of life except to role-emotional (r = -.18; p > .05). Habitual and maximal joint pain correlated with all items except to role-emotional (r = - .19 and r = - .09, respectively) and mental component score (r = - .16 and r = - .07, respectively). Catastrophism and weekly drug intake were inversely correlated with quality of life. Age was positively correlated with perceived quality of life. There were differences in quality of life as a function of the severity of haemophilia and the intake of drugs for pain control. CONCLUSIONS The perceived quality of life of adult patients with haemophilia is worse than that of the Spanish population. Pain, kinesiophobia, catastrophism, haemophilia severity and the intake of pain-control medication influence the quality of life of these patients.
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Affiliation(s)
| | | | - Alba Ortiz-Pérez
- Health Psychologist, Free Exercise of the Profession, Madrid, Spain
| | - Rubén Cuesta-Barriuso
- Department of Physiotherapy, University of Murcia, Murcia, Spain.
- Royal Victoria Eugenia Foundation, Madrid, Spain.
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9
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Costs of the management of hemophilia A with inhibitors in Spain. GLOBAL & REGIONAL HEALTH TECHNOLOGY ASSESSMENT 2021; 8:35-42. [PMID: 36627877 PMCID: PMC9616192 DOI: 10.33393/grhta.2021.2234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 02/24/2021] [Indexed: 01/13/2023] Open
Abstract
Introduction Emicizumab is a first-in-class monoclonal antibody, recently authorized for the treatment of hemophilia A with inhibitors. This study aims to estimate the direct and indirect costs of the management of hemophilia A with inhibitors, in adult and pediatric patients, including the prophylaxis with emicizumab. Methods We calculated the costs of the on-demand and prophylactic treatments with bypassing agents (activated prothrombin complex concentrate and recombinant activated factor VII) and the emicizumab prophylaxis, from the societal perspective, over 1 year. The study considered direct healthcare costs (drugs, visits, tests, and hospitalizations), direct non-healthcare costs (informal caregivers), and indirect costs (productivity loss). Data were obtained from a literature review and were validated by an expert group. Costs were expressed in 2019 euros. Results Our results showed that the annual costs of the prophylactic treatment per patient varied between €543,062.99 and €821,415.77 for adults, and €182,764.43 and €319,826.59 for children, while on-demand treatment was €532,706.84 and €789,341.91 in adults, and €167,523.05 and €238,304.71 in pediatric patients. In relation to other prophylactic therapies, emicizumab showed the lowest costs, with up to a 34% and 43% reduction in the management cost of adult and pediatric patients, respectively. It reduced the bleeding events and administration costs, as this drug is less frequently administered by subcutaneous route. Emicizumab prophylaxis also decreased the cost of other healthcare resources such as visits, tests, and hospitalizations, as well as indirect costs. Conclusion In comparison to prophylaxis with bypassing agents, emicizumab reduced direct and indirect costs, resulting in cost savings for the National Health System and society.
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10
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Yoon HS, Han Y, Kim YJ, Kim MJ, Byun JM, Youk T, Lee JH, Park TS, Yoo J. Epidemiology of Congenital Bleeding Disorders: a Nationwide Population-based Korean Study. J Korean Med Sci 2020; 35:e350. [PMID: 33045773 PMCID: PMC7550232 DOI: 10.3346/jkms.2020.35.e350] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 08/02/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Except for data in the Korea Hemophilia Foundation Registry, little is known of the epidemiology of congenital bleeding disorders in Korea. METHODS Data were obtained from the Korean Health Insurance Review and Assessment Service (HIRA) database. RESULTS From 2010 to 2015, there were 2,029 patients with congenital bleeding disorders in the Korean HIRA database: 38% (n = 775) of these patients had hemophilia A (HA), 25% (n = 517) had von Willebrand disease (vWD), 7% (n = 132) had hemophilia B (HB), and 25% (n = 513) had less common factor deficiencies. The estimated age-standardized incidence rate (ASR) of HA and HB was 1.78-3.15/100,000 and 0.31-0.51/100,000, respectively. That of vWD was 1.38-1.95/100,000. The estimated ASR of HA showed increase over time though the number of new patients did not increase. Most patients with congenital bleeding disorders were younger than 19 years old (47.8%), and most were registered in Gyeonggi (22.1%) and Seoul (19.2%). CONCLUSION This is the first nationwide population-based study of congenital bleeding disorders in Korea. This study provides data that will enable more accurate estimations of patients with vWD. This information will help advance the comprehensive care of congenital bleeding disorders. We need to continue to obtain more detailed information on patients to improve the management of these diseases.
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Affiliation(s)
- Hoi Soo Yoon
- Department of Pediatrics, Kyung Hee University School of Medicine, Seoul, Korea
| | - Yujin Han
- Department of Laboratory Medicine, Kyung Hee University School of Medicine, Seoul, Korea
| | - Young Jin Kim
- Department of Laboratory Medicine, Kyung Hee University School of Medicine, Seoul, Korea
| | | | - Ja Min Byun
- Department of Internal Medicine, Seoul National University College of Medicine, National University Hospital, Seoul, Korea
| | - Taemi Youk
- Research Institute, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Jae Hee Lee
- Department of Pediatrics, Chosun University Hospital, Gwangju, Korea
| | - Tae Sung Park
- Department of Laboratory Medicine, Kyung Hee University School of Medicine, Seoul, Korea
| | - Jongha Yoo
- Department of Laboratory Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Korea.
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11
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Brown LJ, La HA, Li J, Brunner M, Snoke M, Kerr AM. The societal burden of haemophilia A. I - A snapshot of haemophilia A in Australia and beyond. Haemophilia 2020; 26 Suppl 5:3-10. [PMID: 32935397 DOI: 10.1111/hae.14102] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 05/03/2020] [Accepted: 06/18/2020] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Few studies, both in Australia and overseas, have examined the social impacts of living with haemophilia A (HA) or the economic costs associated with the disorder. The purpose of this paper is to examine the epidemiology and societal burden of people with HA (PwHA) in Australia, with a particular focus on men with this disorder. METHODS The epidemiology and societal burden of HA in Australia, with a particular focus on men with this disorder, were assessed, using data available in the Australian and international literature and publicly available data. RESULTS The mean annual prevalence of HA is approximately 1-2 per 10 000 males. Prophylactic treatment is used in one-quarter (25.1%) of people with moderate HA, and 82.2% of people with severe HA. Within the latter group, 16.1% have inhibitors for Factor VIII, predisposing them to worse morbidity, mortality and quality of life when compared to the non-inhibitor population. Joint pain and joint disease occur commonly in PwHA, with up to 70% of adults with HA experiencing joint problems. HA is associated with poor physical health, and PwHA miss school and work due to bleeding-related events. CONCLUSION HA is associated with substantial economic burden; with large differences in costs reported between countries. Overall, HA imposes a significant burden of disease on PwHA, their families and the community at large.
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Affiliation(s)
- Laurie J Brown
- NATSEM, Institute for Governance and Policy Analysis, University of Canberra, Canberra, ACT, Australia
| | - Hai A La
- NATSEM, Institute for Governance and Policy Analysis, University of Canberra, Canberra, ACT, Australia
| | - Jinjing Li
- NATSEM, Institute for Governance and Policy Analysis, University of Canberra, Canberra, ACT, Australia
| | | | - Martin Snoke
- Roche Products Pty Limited, Sydney, NSW, Australia
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Mareque M, Mingot-Castellano ME, López-Fernández MF, Álvarez-Román MT, Oyagüez I. Prophylaxis therapy with bypassing agents in patients with haemophilia A and inhibitors undergoing surgery: A cost analysis in Spain. Eur J Haematol 2020; 105:94-100. [PMID: 32220097 PMCID: PMC7383573 DOI: 10.1111/ejh.13414] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 03/18/2020] [Accepted: 03/19/2020] [Indexed: 01/19/2023]
Abstract
Objectives This study estimated the cost of prophylaxis with activated prothrombin complex concentrate (aPCC) and recombinant activated factor VIIa (rFVIIa) in surgical patients with haemophilia A and inhibitors in Spain. Methods A decision‐analytic model was developed to estimate the cost to the Spanish National Health System of providing haemostatic coverage in this haemophilia population, with age distribution and average weight derived from the literature, and the annual number of surgeries (0.33 per patient) from local data. Drug costs were calculated from official ex‐factory prices with a 7.5% mandatory deduction and recommended dosing regimens. Results The estimated average costs per patient were €10 100.73 (aPCC) and €14 265.89 (rFVIIa) for dental extraction, €24 043.88 (aPCC) and €62 301.08 (rFVIIa) for minor surgery and €126 595.81 (aPCC) and €347 731.09 (rFVIIa) for major surgery. Assuming an estimated 23 annual surgeries in this population (N = 69), distributed as 19% dental extraction, 50% minor surgery and 31% major surgery, the total annual cost of prophylaxis was €1 209 682.35 with aPCC and €3 221 929.28 with rFVIIa. Conclusions aPCC costs were 62.5% lower than rFVIIa. Assuming potential clinical equivalence, aPCC is a potentially cost‐saving option for surgical patients with haemophilia A and inhibitors.
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Affiliation(s)
- María Mareque
- Pharmacoeconomics & Outcomes Research Iberia (PORIB), Madrid, Spain
| | | | | | | | - Itziar Oyagüez
- Pharmacoeconomics & Outcomes Research Iberia (PORIB), Madrid, Spain
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Álvarez-Román MT, Cuervo-Arango I, Pérez-Santamarina R, Poveda JL, Romero JA, Santamaría A, Trillo-Mata JL, Tort M, Badia X. Determining the value contribution of emicizumab (Hemlibra®) for the prophylaxis of haemophilia A with inhibitors in Spain by multi-criteria decision analysis. GLOBAL & REGIONAL HEALTH TECHNOLOGY ASSESSMENT 2019. [DOI: 10.1177/2284240319880534] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Patients with moderate to severe haemophilia A are at a higher risk of developing FVIII inhibitors that require the use of more costly and less effective treatments. The objective of this study was to determine the value of emicizumab for the prophylaxis of haemophilia A with inhibitors compared to the current therapeutic alternatives, activated prothrombin complex concentrate and recombinant factor VIIa through reflective Multi-Criteria Decision Analysis. The EVIDEM framework adapted to orphan drugs and weighted by a sample of 98 national and regional Spanish evaluators was used. Two structured evidence matrices were developed: emicizumab against activated prothrombin complex concentrate and emicizumab against recombinant factor VIIa. A multidisciplinary team of haemophilia experts rated each of the criteria. Mean and standard deviation were calculated by each criterion and discussed among all participants. Haemophilia A with inhibitors was perceived as a severe disease with high unmet needs. Emicizumab was rated with higher efficacy, therapeutic benefit and quality of life than comparators. When administered alone for the prevention of bleeding events, emicizumab had slightly better safety and tolerability profile than activated prothrombin complex concentrate and similar with recombinant factor VIIa. The inclusion of emicizumab in clinical practice guidelines was valued positively by the members of the panel. Overall, value of emicizumab was higher than activated prothrombin complex concentrate and recombinant factor VIIa, mostly because of efficacy and therapeutic benefit in reducing treated haemorrhages. Reflective Multi-Criteria Decision Analysis has proven to be a feasible method to determine the value contribution of comparative therapies in haemophilia.
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