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Moka E, Ntova Z, Gavriilaki E, Kotsiou N, Chissan S, Papadopoulou T, Vakalopoulou S. A Retrospective Observational Study of Quality of Life in a Northern Greece Population of People with Haemophilia. Life (Basel) 2024; 14:697. [PMID: 38929680 PMCID: PMC11205034 DOI: 10.3390/life14060697] [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: 04/12/2024] [Revised: 05/15/2024] [Accepted: 05/25/2024] [Indexed: 06/28/2024] Open
Abstract
Haemophilia presents a significant challenge to the quality of life of affected individuals. Evaluating the health-related quality of life (HRQoL) of people with haemophilia (PwH) provides a valuable mean of assessing their perception of overall care outcomes, while also identifying influential factors across various age and condition severity demographics. This observational retrospective study determined the HRQoL of 100 adult PwH in Northern Greece through comprehensive analysis and interpretation of their HRQoL levels, particularly in domains concerning their physical, emotional, and mental well-being, obtained through the Haem-A-QoL index questionnaire. Disease severity and young age were significantly associated with the administration of prophylactic treatment (84.2% of patients with severe haemophilia and 65.2% of patients aged 18-30). The mean Haem-A-QoL score was 40.11 ± 17.38, with the lowest HRQoL observed in the 46-60 age group (46.16), and the highest in the ≥61 age groups (35.16). Notably, the 'Sports/Leisure' and 'Physical Health' domains exhibited the highest scores, in contrast to 'Family Planning' and 'Relationships/Sexuality'. Individuals with mild haemophilia recorded the lowest mean score (39.38), while those with a severe condition exhibited the highest (41.23). Age, disease severity, and physical activity emerged as primary determinants significantly affecting HRQoL outcomes.
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Affiliation(s)
| | | | - Eleni Gavriilaki
- 2nd Propedeutic Department of Internal Medicine, Hippokration General Hospital, 54642 Thessaloniki, Greece; (E.M.); (Z.N.); (N.K.); (S.C.); (T.P.); (S.V.)
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Celikel P, Ozturk N, Bas A, Sengul F. Evaluation of Pediatric Oral Health-Related Quality of Life score in children with traumatic dental avulsion injury: A Questionnaire-Based Cross-Sectional survey. Dent Traumatol 2024. [PMID: 38576399 DOI: 10.1111/edt.12957] [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: 02/15/2024] [Revised: 03/19/2024] [Accepted: 03/20/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND/AIM Dental avulsion injury, being one of the traumatic dental injuries, has negative impacts on children's life quality. This study aims to evaluate the Pediatric Oral Health-Related Quality of Life (POQL) scores of children with dental avulsion history from their perspective. MATERIALS AND METHODS The population of this cross-sectional study comprises 40 patients, aged between 8 and 14, who have a history of dental avulsion, in comparison to 40 other healthy peers. A questionnaire including general questions (such as age, gender, loss of tooth due to dental avulsion, malocclusion) and POQL instrument, with subscales including physical function, social function, emotional function, and role function, were completed by these children. Mann-Whitney U-test is used when comparing the POQL scores. RESULTS The social scores (median: 47, interquartile range [IQR]: 17-95) and total score percentages (median: 30, IQR: 14-40) of children with a history of avulsion were higher than those of their healthy peers (p < 0.05). The higher total POQL scores among girls (median: 37, IQR: 31-47) with a history of dental avulsion compared to boys (median: 19, IQR: 8-34) (p = .002) can be attributed to girls achieving higher scores in both social (median: 81, IQR: 39-100) and emotional (median: 35, IQR: 17-47) scores following dental avulsion (psocial = .02, pemotional = .006). Whether the avulsed tooth is replanted or not, it has not made any visible impact on the POQL scores. However, the loss of replanted teeth over time has created a borderline significant difference in emotional scores (median: 21, IQR: 11-35, p = .055). CONCLUSION Within the limits of our study, avulsion injuries have negative effects on children's emotional, social, and total quality of life. Even though avulsion injuries may be inevitable, to prevent these negative effects, it is vital to provide appropriate psychological support in the treatment of these children.
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Affiliation(s)
- Peris Celikel
- Department of Pediatric Dentistry, Faculty of Dentistry, Ataturk University, Erzurum, Turkey
| | - Nilay Ozturk
- Department of Pediatric Dentistry, Faculty of Dentistry, Ataturk University, Erzurum, Turkey
| | - Aybike Bas
- Department of Pediatric Dentistry, Faculty of Dentistry, Ataturk University, Erzurum, Turkey
| | - Fatih Sengul
- Department of Pediatric Dentistry, Faculty of Dentistry, Ataturk University, Erzurum, Turkey
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Hay CRM, Makris M, Shima M, Nagao A, Jiménez-Yuste V, Skinner M, Kessler CM, von Mackensen S. Association of patient, treatment and disease characteristics with patient-reported outcomes: Results of the ECHO Registry. Haemophilia 2024; 30:106-115. [PMID: 38030962 DOI: 10.1111/hae.14895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 09/22/2023] [Accepted: 09/29/2023] [Indexed: 12/01/2023]
Abstract
INTRODUCTION Patient-reported outcomes (PROs) in people living with haemophilia A (PLWHA) are often under-reported. Investigating PROs from a single study with a diverse population of PLWHA is valuable, irrespective of FVIII product or regimen. AIM To report available data from the Expanding Communications on Haemophilia A Outcomes (ECHO) registry investigating the associations of patient, treatment and disease characteristics with PROs and clinical outcomes in PLWHA. METHODS ECHO (NCT02396862), a prospective, multinational, observational registry, enrolled participants aged ≥16 years with moderate or severe haemophilia A using any product or treatment regimen. Data collection, including a variety of PRO questionnaires, was planned at baseline and annually for ≥2 years. Associations between PRO scores and patient, treatment and disease characteristics were determined by statistical analyses. RESULTS ECHO was terminated early owing to logistical constraints. Baseline data were available from 269 PLWHA from Europe, the United States and Japan. Most participants received prophylactic treatment (76.2%), with those using extended-half-life products (10.0%) reporting higher treatment satisfaction. Older age and body weight >30 kg/m2 (>BMI) were associated with poorer joint health. Older age was associated with poorer physical functioning and work productivity. Health-related quality of life and pain interference also deteriorated with age and >BMI; >BMI also increased pain severity scores. CONCLUSION ECHO captured a variety of disease characteristics, treatment patterns, PROs and clinical outcomes obtained in real-world practice with ≤1 year's follow-up. Older age, poorer joint health and >BMI adversely affected multiple aspects of participant well-being.
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Affiliation(s)
- Charles R M Hay
- Manchester University Department of Haematology, Manchester, UK
| | - Michael Makris
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | | | - Azusa Nagao
- Department of Blood Coagulation, Ogikubo Hospital, Tokyo, Japan
| | | | - Mark Skinner
- Institute for Policy Advancement Ltd., Washington, DC, USA
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | | | - Sylvia von Mackensen
- Department of Medical Psychology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
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Cuesta-Barriuso R, Donoso-Úbeda E, Meroño-Gallut J, Ucero-Lozano R, Pérez-Llanes R. Hemophilic Arthropathy: Barriers to Early Diagnosis and Management. J Blood Med 2022; 13:589-601. [PMID: 36277171 PMCID: PMC9586168 DOI: 10.2147/jbm.s343924] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 09/29/2022] [Indexed: 11/05/2022] Open
Abstract
Hemophilia is a congenital coagulopathy characterized by a deficiency of one of the clotting factors. It is characterized by the development of hematomas and hemarthrosis, either spontaneously or after minor trauma. The recurrence of hemarthroses leads to progressive and degenerative joint damage from childhood (hemophilic arthropathy). This arthropathy is characterized by disabling physical effects that limit the functionality and quality of life of these patients. Medical progress achieved over the last decade in the drug treatment of hemophilia has improved the medium and long-term prospects of patients with more effective and long-lasting drugs. The universal use of safer, more effective and prolonged prophylactic treatments may promote the prevention of bleeding, and also therefore, of the development of hemarthrosis and joint damage. A number of imaging instruments have been developed for the assessment of hemarthrosis and hemophilic arthropathy, using ultrasound, magnetic resonance imaging and simple radiology. Different physical examination scores and questionnaires allow the assessment of joint health, self-perceived activity and functionality of patients with hemophilia. The approach to these patients should be interdisciplinary. Assessment of the processes that affect pain in these patients and the development of pain education models should be implemented. Expert advice and information to patients with hemophilia should be based on individual functional prevention diagnoses, advice on available therapies and sports practice, as well as health recommendations.
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Affiliation(s)
- Rubén Cuesta-Barriuso
- Department of Surgery and Medical-Surgical Specialties, University of Oviedo, Oviedo, Spain
- Royal Victoria Eugenia Foundation, Madrid, Spain
| | - Elena Donoso-Úbeda
- Department of Physiotherapy, Catholic University San Antonio-UCAM, Murcia, Spain
| | | | | | - Raúl Pérez-Llanes
- Department of Physiotherapy, Catholic University San Antonio-UCAM, Murcia, Spain
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Niu J, Ning L, Zhang Q, Liu Z, Ma Y, Xu X, Wu Q, Hao Y, Cui Y, Liu C. Health-related quality of life of patients with haemophilia: a cross-sectional survey in the Northeast of China. BMJ Open 2022; 12:e056668. [PMID: 35105597 PMCID: PMC8808448 DOI: 10.1136/bmjopen-2021-056668] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Haemophilia is a hereditary, chronic and haemorrhagic disorder caused by a deficiency in coagulation factors. Long-term spontaneous bleeding of joints and soft tissues can seriously affect the quality of life of patients. OBJECTIVE The study aimed to assess the health-related quality of life (HRQoL) of patients with haemophilia and associated factors. METHODS A snowball sampling strategy was adopted to select study participants. Eligible participants were those who were 18 years or older and had mild, moderate or severe haemophilia. They were asked to self-complete a questionnaire, collecting data regarding their sociodemographic characteristics, target joint status and HRQoL measured by the EQ-5D-5L(a tool developed by the European quality of life (EuroQol) Group). RESULTS The respondents reported a mean EQ-5Dutility(country-specific valuesets for the EQ-5D-5L) score of 0.51 (SD=0.34). Those with severe haemophilia had a lower utility score than those with mild/moderate haemophilia (0.46±0.37 vs 0.56±0.30, p=0.737). The linear regression analyses showed that older age (>25 years), two or more target joints, not working, low levels of knowledge of the disease and borrowing money to pay for medical treatments were associated with lower EQ-5Dutility scores. CONCLUSION Low HRQoL of patients with haemophilia is evident in China. Social support needs to be strengthened to address this issue.
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Affiliation(s)
- Jinyu Niu
- School of Health Management, Harbin Medical University, Harbin, China
| | - Liangwen Ning
- School of Health Management, Harbin Medical University, Harbin, China
| | - Qiao Zhang
- School of Health Management, Harbin Medical University, Harbin, China
| | - Ze Liu
- School of Health Management, Harbin Medical University, Harbin, China
| | - Yi Ma
- School of Health Management, Harbin Medical University, Harbin, China
| | - Xiaoxue Xu
- School of Health Management, Harbin Medical University, Harbin, China
| | - Qunhong Wu
- School of Health Management, Harbin Medical University, Harbin, China
| | - Yanhua Hao
- School of Health Management, Harbin Medical University, Harbin, China
| | - Yu Cui
- School of Health Management, Harbin Medical University, Harbin, China
| | - Chaojie Liu
- School of Psychology & Public Health, La Trobe University, Melbourne, VIC, Australia
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Kavaklı K, Özbek SS, Antmen AB, Şahin F, Aytaç ŞS, Küpesiz A, Zülfikar B, Sönmez M, Çalışkan Ü, Balkan C, Akbaş T, Arpacı T, Tamsel İ, Seber T, Oğuz B, Çevikol C, Bulakçı M, Koşucu P, Aydoğdu D, Şaşmaz İ, Tüysüz G, Koç B, Tokgöz H, Mehrekula Z, Özkan B. Impact of the HEAD-US Scoring System for Observing the Protective Effect of Prophylaxis in Hemophilia Patients: A Prospective, Multicenter, Observational Study. Turk J Haematol 2021; 38:101-110. [PMID: 33508912 PMCID: PMC8171214 DOI: 10.4274/tjh.galenos.2021.2020.0717] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objective: This study aimed to observe the preventive effect of prophylactic treatment on joint health in people with hemophilia (PwH) and to investigate the importance of integration of ultrasonographic examination into clinical and radiological evaluation of the joints. Materials and Methods: This national, multicenter, prospective, observational study included male patients aged ≥6 years with the diagnosis of moderate or severe hemophilia A or B from 8 centers across Turkey between January 2017 and March 2019. Patients were followed for 1 year with 5 visits (baseline and 3rd, 6th, 9th, and 12th month visits). The Hemophilia Joint Health Score (HJHS) was used for physical examination of joints, the Pettersson scoring system was used for radiological assessment, point-of-care (POC) ultrasonography was used for bilateral examinations of joints, and the Hemophilia Early Arthropathy Detection with Ultrasound (HEAD-US) score was used for evaluation of ultrasonography results. Results: Seventy-three PwH, of whom 62 had hemophilia A and 11 had hemophilia B, were included and 24.7% had target joints at baseline. The HJHS and HEAD-US scores were significantly increased at the 12th month in all patients. These scores were also higher in the hemophilia A subgroup than the hemophilia B subgroup. However, in the childhood group, the increment of scores was not significant. The HEAD-US total score was significantly correlated with both the HJHS total score and Pettersson total score at baseline and at the 12th month. Conclusion: The HEAD-US and HJHS scoring systems are valuable tools during follow-up examinations of PwH and they complement each other. We suggest that POC ultrasonographic evaluation and the HEAD-US scoring system may be integrated into differential diagnosis of bleeding and long-term monitoring for joint health as a routine procedure.
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Affiliation(s)
- Kaan Kavaklı
- Ege University Children’s Hospital, Clinic of Children’s Health and Diseases, Division of Pediatric Hematology, İzmir, Turkey
| | - Süha Süreyya Özbek
- Ege University Medical Faculty Hospital, Clinic of Radiology, Division of Hematology, İzmir, Turkey
| | - Ali Bülent Antmen
- Acıbadem Adana Hospital, Clinic of Pediatric Hematology, Adana, Turkey
| | - Fahri Şahin
- Ege University Medical Faculty Hospital, Clinic of Internal Diseases, Division of Hematology, İzmir, Turkey
| | - Şevkiye Selin Aytaç
- Hacettepe University Faculty of Medicine, Department of Children’s Health and Diseases, Division of Pediatric Hematology, Ankara, Turkey
| | - Alphan Küpesiz
- Akdeniz University Hospital, Clinic of Children’s Health and Diseases, Antalya, Turkey
| | - Bülent Zülfikar
- İstanbul University Hemophilia Comprehensive Care Center, İstanbul, Turkey
| | - Mehmet Sönmez
- Karadeniz Technical University Medical Faculty Farabi Hospital, Clinic of Internal Diseases, Division of Hematology, Trabzon, Turkey
| | - Ümran Çalışkan
- Necmettin Erbakan University Meram Medical Faculty Hospital, Department of Children’s Health and Diseases, Konya, Turkey
| | - Can Balkan
- Ege University Children’s Hospital, Clinic of Children’s Health and Diseases, Division of Pediatric Hematology, İzmir, Turkey
| | - Tuğana Akbaş
- Acıbadem Adana Hospital, Clinic of Radiology, Adana, Turkey
| | - Taner Arpacı
- Acıbadem Adana Hospital, Clinic of Radiology, Adana, Turkey
| | - İpek Tamsel
- Ege University Medical Faculty Hospital, Clinic of Radiology, Division of Hematology, İzmir, Turkey
| | - Turgut Seber
- Hacettepe University Faculty of Medicine, Department of Radiology, Ankara, Turkey
| | - Berna Oğuz
- Hacettepe University Faculty of Medicine, Department of Radiology, Ankara, Turkey
| | - Can Çevikol
- Akdeniz University Hospital, Clinic of Radiology, Antalya, Turkey
| | - Mesut Bulakçı
- İstanbul University Hemophilia Comprehensive Care Center, İstanbul, Turkey
| | - Polat Koşucu
- Karadeniz Technical University Medical Faculty Farabi Hospital, Clinic of Radiology, Trabzon, Turkey
| | - Demet Aydoğdu
- Necmettin Erbakan University Meram Medical Faculty Hospital, Clinic of Radiology, Konya, Turkey
| | - İlgen Şaşmaz
- Acıbadem Adana Hospital, Clinic of Pediatric Hematology, Adana, Turkey
| | - Gülen Tüysüz
- Akdeniz University Hospital, Clinic of Children’s Health and Diseases, Antalya, Turkey
| | - Başak Koç
- İstanbul University Hemophilia Comprehensive Care Center, İstanbul, Turkey
| | - Hüseyin Tokgöz
- Necmettin Erbakan University Meram Medical Faculty Hospital, Department of Children’s Health and Diseases, Konya, Turkey
| | - Zuhal Mehrekula
- Ege University Medical Faculty Hospital, Clinic of Internal Diseases, Division of Hematology, İzmir, Turkey
| | - Burcu Özkan
- Pfizer Pharmaceuticals, Rare Disease Department, İstanbul, Turkey
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Bago M, Butkovic A, Preloznik Zupan I, Faganel Kotnik B, Prga I, Bacic Vrca V, Zupancic Salek S. Association between reported medication adherence and health-related quality of life in adult patients with haemophilia. Int J Clin Pharm 2021; 43:1500-1507. [PMID: 33928481 DOI: 10.1007/s11096-021-01270-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 04/22/2021] [Indexed: 11/28/2022]
Abstract
Background Medication adherence is an important issue, not just health-related, for patients with haemophilia. Poor medication adherence to long-term therapies limits the potential of effective treatments to improve patients' health-related quality of life. Objective The aim of this study was to investigate the association of reported medication adherence and health-related quality of life in patients with haemophilia. Setting Data were collected from patients at University Hospital Centre Zagreb, Croatia and at University Medical Centre Ljubljana, Slovenia. Method Adult male patients with severe or moderate haemophilia receiving prophylactic treatment were eligible for the study. Main outcome measure Implementation phase of medication adherence was assessed with the self-reported VERITAS-Pro instrument and health-related quality of life with SF-36v2. Results A total of 82 participants were included in the study (median age was 44.50, range 18-73 years). The majority of our participants reported being adherent to medication (83%). Participants showed better health in the mental health domains and Mental Component Summary than in the physical health domains and Physical Component Summary. After controlling for demographic, socioeconomic and clinical predictors, better reported medication adherence explained an additional 4-6% of better health variance in Bodily Pain and Social Functioning domains and Mental Component Summary. Conclusion We found that reported medication adherence can contribute to better health-related quality of life in patients with haemophilia. Since life with a chronic condition is demanding, it is an important finding that medication adherence to replacement therapy can improve life conditions for patients with haemophilia.
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Affiliation(s)
- Martina Bago
- Andrija Stampar Teaching Institute of Public Health, Zagreb, Croatia.
| | - Ana Butkovic
- Faculty of Humanities and Social Sciences, University of Zagreb, Zagreb, Croatia
| | - Irena Preloznik Zupan
- University Medical Center Ljubljana, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Barbara Faganel Kotnik
- University Medical Center Ljubljana, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Ivana Prga
- Andrija Stampar Teaching Institute of Public Health, Zagreb, Croatia
| | - Vesna Bacic Vrca
- Clinical Hospital Dubrava, Zagreb, Croatia.,Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia
| | - Silva Zupancic Salek
- University Hospital Centre Zagreb, Zagreb, Croatia.,Faculty of Medicine, University of Zagreb, Zagreb, Croatia
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Mohan R, Radhakrishnan N, Varadarajan M, Anand S. Assessing the current knowledge, attitude and behaviour of adolescents and young adults living with haemophilia. Haemophilia 2020; 27:e180-e186. [PMID: 33278862 DOI: 10.1111/hae.14229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 11/24/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION There is significant incidence of Haemophilia in India, with second largest number of persons with Haemophilia A. 20,778 patients registered with Haemophilia Foundation of India in 2018. Research in India includes diagnostic studies, complications and co-morbidities, prenatal diagnosis, inhibitor development and gene therapy. Limited is known about quality of life of these patients. Since Haemophilia leads to the loss of 'normal lifestyle' in young people resulting in emotional distress and depression, it is important to analyse Knowledge, Attitude and Behaviour of persons with Haemophilia. AIM The aim of the study is to focus on exploring the status of Haemophilia and knowledge, attitude, behaviour of adolescents and youths with haemophilia with the objectives to study 1) the current medical status of haemophilia amongst target population; 2) the knowledge, attitude and behaviour of patients with haemophilia towards their condition. METHODS Respondents in the age group of 15-30 years, who were registered with the Hemophilia Treatment Centers of Government Hospitals/Hemophilia Societies, were interviewed. Data were collected using a structured questionnaire. The study was conducted in two different states and with respondents of two different age groups. FINDINGS Most respondents suffered from severe haemophilia and co-morbidities such as anxiety, stress, chronic pain and head-ache. All of them felt that haemophilia interferes in leading a normal life and perceive a grim future. CONCLUSION Young people in India need technical, financial and psychological support to prevent complications related to haemophilia. While most of them take responsibility for their health, more behavioural changes need to be inducted to improve quality of life.
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Affiliation(s)
- Richa Mohan
- Empowering Minds Society for Research and Development, New Delhi, India
| | | | - Meera Varadarajan
- Department of Clinical Hematology, Bangalore Medical College and Research Institute, Bangalore, India
| | - Sandip Anand
- Xavier University Bhubaneswar, Bhubaneswar, India
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Barnett T, Goldfeld S, Kelaher M. Evaluating the Effectiveness of Education Support Programs for Hospitalized Students With Chronic Health Conditions: Protocol for a Feasibility Study of a Controlled Trial. CONTINUITY IN EDUCATION 2020; 1:126-135. [PMID: 38774528 PMCID: PMC11104333 DOI: 10.5334/cie.10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 02/20/2020] [Indexed: 05/24/2024]
Abstract
Chronic health conditions in children and young people can have a significant impact on their ability to maintain engagement in school, education, and learning. While this functional limitation affects only about 1.6% of all children and young people, the absolute number is not inconsequential. In Australia, for example, the number is in the order of 67,000 children and young people. Furthermore, research has shown that this group of young learners are at increased risk of lower academic, social, and emotional and quality of life outcomes than their healthy peers, both in the short and the longer term. For this reason, most pediatric hospitals in western developed countries have hospital-based schools that aim to prevent children and young people with a chronic health condition from disengaging from school, education, and learning. However, there is a lack of robust evidence of the effectiveness of these education support programs. This protocol for a feasibility study of the effectiveness of evaluating an education support program in Australia aims to identify a priori the methodological key features of a robust trial, including developing an answerable research question, choosing a controlled study design that compares the outcomes of both an intervention group and a well-matched non-intervention or control group, eligibility criteria, important and validated outcome measures such as quality of life, and how statistical data should be analyzed and reported. Lessons learned from the proposed feasibility study will be used to inform a larger-scale study.
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The evolving landscape of gene therapy for congenital haemophilia: An unprecedented, problematic but promising opportunity for worldwide clinical studies. Blood Rev 2020; 46:100737. [PMID: 32739122 DOI: 10.1016/j.blre.2020.100737] [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: 03/24/2020] [Revised: 06/26/2020] [Accepted: 07/15/2020] [Indexed: 01/19/2023]
Abstract
With liver-directed gene therapy, congenital haemophilia has the potential to progress from an incurable to a phenotypically curable condition. However, the proportion of haemophilia population likely to benefit from gene therapy remains to be established. Achieving a phenotypic curative goal is presently hampered by: 1) availability of effective treatments (e.g. extended half-life products, non-factor therapies) that address major unmet needs in haemophilia; 2) key differences between hope and reality that patients undergoing gene therapy face (e.g. unknown risks and long-term follow-up, durability of the therapeutic effect, possibility of re-administering the vector), 3) lack of expertise of health care professionals (HCP) in managing/monitoring unexpected side effects in patients, and 4) lack of expertise of HCP in advising payers on key issues for cost-effectiveness analyses of gene therapy (e.g., eligibility criteria, predictability of response, unknown risks, long-term complications). There is also uncertainty about the possibility to absorb the cost of the "one-time, one-dose cure" by payers that are used to different payment models. An active partnership between regulators, payers, patients and health care professionals is key to identify patient sub-populations that might benefit the most from gene therapy, and to align the interests of patients (needing effective disease correction and improved quality of life) and pharma companies (reluctant to lose the profitability of lifelong repeated treatments). Educational programs will provide the healthcare chain with information on the strategy that is expected to transform morbidity and mortality patterns and how it should be regarded as part of the future therapeutic options in haemophilia.
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11
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Lambert C, Meité N, Sanogo I, Lobet S, von Mackensen S, Hermans C. Cross-cultural adaptation and validation of Haem-A-QoL in Côte d'Ivoire. Haemophilia 2020; 26:459-466. [PMID: 32394627 DOI: 10.1111/hae.13987] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 03/10/2020] [Accepted: 03/16/2020] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Health-related quality (HRQoL) evaluations are considered essential outcomes in the assessment of people with haemophilia. In developing countries, reliable HRQoL data are even more critical whilst enabling government agencies to develop national haemophilia care programmes. However, validated tools are not yet available in sub-Saharan African countries. AIMS This study sought to perform a cultural adaptation and validation of the Haemophilia Quality of Life Questionnaire for Adults (Haem-A-QoL) in Côte d'Ivoire. METHODS The process comprised several steps, such as linguistic adaptation, cognitive debriefing interviews with adult haemophilia patients and psychometric testing, including reliability (internal consistency, test-retest reliability) and validity assessments (convergent with EQ-5D-5L, criterion with HJHS 2.1, known-groups). RESULTS The final Ivoirian Haem-A-QoL version was obtained in December 2017 following linguistic adaptation and cognitive debriefings with six participants. The validation process included 25 patients, mainly haemophilia A patients (88%) with severe forms (80%). All participants received on-demand treatment, with joint impairment observed in 92%. Internal consistency and test-retest reliability of the Ivoirian Haem-A-QoL were very good. A Pearson correlation analysis revealed a moderate negative correlation between EQ-VAS and total Haem-A-QoL scores and a moderate positive correlation between HJHS 2.1 and total Haem-A-QoL scores. CONCLUSIONS A cross-culturally adapted and validated Haem-A-QoL version in Côte d'Ivoire is now available, enabling measurement of intervention outcomes in the targeted population and Ivorian participation to multisite international trials. However, further work is needed to ensure optimal understanding of HRQoL questionnaires, previously developed in culturally distinct countries, with almost unlimited access to different treatment regimens.
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Affiliation(s)
- Catherine Lambert
- Haemostasis and Thrombosis Unit, Division of Hematology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - N'Dogomo Meité
- Division of Clinical Hematology, Centre Hospitalier Universitaire de Yopougon, Abidjan, Ivory Coast
| | - Ibrahima Sanogo
- Division of Clinical Hematology, Centre Hospitalier Universitaire de Yopougon, Abidjan, Ivory Coast
| | - Sébastien Lobet
- Haemostasis and Thrombosis Unit, Division of Hematology, Cliniques Universitaires Saint-Luc, Brussels, Belgium.,Division of Physical Medicine and Rehabilitation, Cliniques Universitaires Saint-Luc, Brussels, Belgium.,Secteur des Sciences de la Santé, Institut de Recherche Expérimentale et Clinique, Neuromusculoskeletal Lab, Université Catholique de Louvain, Brussels, Belgium
| | - Sylvia von Mackensen
- Department of Medical Psychology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Cedric Hermans
- Haemostasis and Thrombosis Unit, Division of Hematology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
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12
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Negri L, Buzzi A, Aru AB, Cannavò A, Castegnaro C, Fasulo MR, Lassandro G, Rocino A, Santoro C, Sottilotta G, Giordano P, Mazzucconi MG, Mura R, Peyvandi F, Delle Fave A. Perceived well-being and mental health in haemophilia. PSYCHOL HEALTH MED 2020; 25:1062-1072. [PMID: 31984755 DOI: 10.1080/13548506.2020.1717556] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The investigation of mental health among persons with haemophilia is mostly focused on negative and disease-related indicators. Literature however shows that psychosocial resources and optimal daily functioning can co-exist with chronic disease. The Dual Continua Model operationalizes positive mental health as 'flourishing', a condition comprising emotional, psychological, and social well-being dimensions. In the present study physical and mental health were comparatively assessed through positive and negative indicators in adults with haemophilia and a control group. Participants included 84 Italian persons with severe haemophilia (Mage = 43.44; SDage = 13.04) and 164 adults without history of chronic illness (Mage = 40.98; SDage = 12.26), who completed the Short Form Health Survey, the Positive and Negative Affect Schedule, and the Mental Health Continuum Short Form. MANOVA and post-hoc t-tests provided evidence of worse general health, lower negative affect and higher psychological well-being among participants with haemophilia compared with the control group. Moreover, the percentage of flourishing individuals was higher among participants with haemophilia. Results support previous evidence suggesting that a chronic disease does not prevent mental well-being attainment. The identification of assets and strengths allowing people with haemophilia to flourish can be fruitfully used to design resource-centered interventions.
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Affiliation(s)
- Luca Negri
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano , Milano, Italy
| | | | - Anna Brigida Aru
- SC Oncoematologia Pediatrica e Patologia della Coagulazione, Ospedale Pediatrico Microcitemico "Antonio Cao" , Cagliari, Italy
| | - Antonino Cannavò
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico , Milano, Italy
| | | | - Maria Rosaria Fasulo
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico , Milano, Italy
| | - Giuseppe Lassandro
- Dipartimento di Scienze Biomediche ed Oncologia Umana - Sezione di Pediatria, Università degli Studi di Bari "Aldo Moro" , Bari, Italy
| | - Angiola Rocino
- UOC di Ematologia - Centro Emofilia e Trombosi, Ospedale Ascalesi - ASL NA1 , Napoli, Italy
| | - Cristina Santoro
- Dipartimento di Biotecnologie Cellulari ed Ematologia, Università degli Studi di Roma La Sapienza , Roma, Italy
| | - Gianluca Sottilotta
- UOSD Microcitemie - Centro Emofilia - Servizio Emostasi e Trombosi, Grande Ospedale Metropolitano "Bianchi-Melacrino Morelli" , Reggio Calabria, Italy
| | - Paola Giordano
- Dipartimento di Scienze Biomediche ed Oncologia Umana - Sezione di Pediatria, Università degli Studi di Bari "Aldo Moro" , Bari, Italy
| | - Maria Gabriella Mazzucconi
- Dipartimento di Biotecnologie Cellulari ed Ematologia, Università degli Studi di Roma La Sapienza , Roma, Italy
| | - Rosamaria Mura
- SC Oncoematologia Pediatrica e Patologia della Coagulazione, Ospedale Pediatrico Microcitemico "Antonio Cao" , Cagliari, Italy
| | - Flora Peyvandi
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico , Milano, Italy
| | - Antonella Delle Fave
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano , Milano, Italy
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13
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Balen EC, Krawczyk M, Gue D, Jackson S, Gouw SC, Bom JG, Sawatzky R. Patient‐centred care in haemophilia: Patient perspectives on visualization and participation in decision‐making. Haemophilia 2019; 25:938-945. [DOI: 10.1111/hae.13830] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 06/25/2019] [Accepted: 07/09/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Erna C. Balen
- Department of Clinical Epidemiology Leiden University Medical Center Leiden The Netherlands
| | - Marian Krawczyk
- Lord Kelvin Adam Smith Fellow, School of Interdisciplinary Studies University of Glasgow Glasgow UK
- School of Nursing Trinity Western University Langley Canada
- Centre for Health Evaluation & Outcome Sciences Providence Health Care Research Institute Vancouver Canada
| | - Deborah Gue
- British Columbia Provincial Bleeding Disorders Program ‐ Adult Division St. Paul’s Hospital Vancouver Canada
| | - Shannon Jackson
- British Columbia Provincial Bleeding Disorders Program ‐ Adult Division St. Paul’s Hospital Vancouver Canada
| | - Samantha C. Gouw
- Department of Clinical Epidemiology Leiden University Medical Center Leiden The Netherlands
- Department of Pediatric Hematology, Emma Children’s Hospital Amsterdam UMC, University of Amsterdam Amsterdam The Netherlands
| | - Johanna G. Bom
- Department of Clinical Epidemiology Leiden University Medical Center Leiden The Netherlands
- Sanquin Research Center for Clinical Transfusion Research Leiden The Netherlands
| | - Richard Sawatzky
- School of Nursing Trinity Western University Langley Canada
- Centre for Health Evaluation & Outcome Sciences Providence Health Care Research Institute Vancouver Canada
- Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
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14
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Trindade GC, Viggiano LGDL, Brant ER, Lopes CADO, Faria MLD, Ribeiro PHNDS, Silva AFDC, Souza DMDR, Lopes ADF, Soares JMA, Pinheiro MDB. Evaluation of quality of life in hemophilia patients using the WHOQOL-bref and Haemo-A-Qol questionnaires. Hematol Transfus Cell Ther 2019; 41:335-341. [PMID: 31409581 PMCID: PMC6978543 DOI: 10.1016/j.htct.2019.03.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 02/26/2019] [Accepted: 03/28/2019] [Indexed: 10/31/2022] Open
Abstract
INTRODUCTION Hemophilia is a coagulopathy caused by a deficiency in coagulation factors VIII (hemophilia A) or IX (hemophilia B). It is a chronic disease and, hence, impairs the quality of life (Qol) of the patients. This study aimed to evaluate the Qol of patients with hemophilia using the WHOQOL-bref and the Haemo-A-Qol instruments, its relation to the clinical condition and its sociodemographic variables. METHODS This is a cross-sectional, epidemiological study, comprising 17 patients with hemophilia, registered at the hemocenter, who met the eligibility criteria. Data were collected using three questionnaires: a semi-structured clinical evaluation form, the WHOQOL-bref and the Haem-A-Qol. RESULTS The average age was 30 years old, and most participants declared themselves to be single (58.82%), without children (64.70%) and employed (58.82%). Hemophilia A was observed in 14 patients and the most severe form of the disease was more prevalent (64.70%). The average score of Qol, estimated by the WHOQOL-bref questionnaire was 74.3; being "social relations" the domain with the highest average. The Haem-A-Qol measured an average of 36.2 and the domain with the highest result was "Family Planning". CONCLUSION Hemophilia had a higher negative impact upon the physical, sports and leisure features in the sample subjects. The analysis of the questionnaires did not reveal statistical agreement between them. Based on this, the Haem-A-Qol is considered the most recommended to evaluate the Qol, as it addresses factors more specifically related to the disease. No statistical significance was observed between the scores of Qol, as for the presence of comorbidities, gravity of the hemophilia and positive serology for infections.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Aline de Freitas Lopes
- Fundação Centro de Hematologia e Hemoterapia do Estado de Minas Gerais, (Hemominas), Divinópolis, MG, Brazil
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15
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Torres-Ortuño A, Cuesta-Barriuso R, Nieto-Munuera J, Galindo-Piñana P, López-Pina JA. Coping strategies in young and adult haemophilia patients: A tool for the adaptation to the disease. Haemophilia 2019; 25:392-397. [PMID: 30994251 DOI: 10.1111/hae.13743] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 02/27/2019] [Accepted: 02/27/2019] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Chronic diseases, after diagnosis, involve changes that have to favour coping with the new situation. The resources used will help control, manage and adapt to the disease. The psychological aspects may be influencing how the individual faces the situation. AIM To assess whether perceptions or beliefs and illness behaviour influence the choice of coping strategies for young and adult patients with haemophilia. METHODS Multicenter cross-sectional descriptive study. We recruited 63 patients with haemophilia A and B, adolescents, young and adults, and both types of treatment. A clinical and sociodemographic data sheet, the Coping Strategies Inventory (CSI), the Illness Perception Questionnaire-revised (IPQ-R) and the Illness Behaviour Questionnaire (IBQ) were used. RESULTS Patients with haemophilia use appropriate coping strategies, both cognitive and behavioural. Most of them are on-demand treatment, and despite arthropathy, they perceive good control of haemophilia. However, patients in prophylactic treatment are those employed more maladaptive coping strategies, less perception of control and hypochondriacal behaviour to the disease. The age variable may be relevant but we did not find significant differences. CONCLUSIONS Coping strategies used by patients with haemophilia are adequate. Although it is noted that the perception of the disease, its controllability or not, affects illness behaviour and consequently how coping with haemophilia. These are based on personal characteristics, cognitive and attitudinal dispositions that the individual consciously use to solve or face adverse situations. The analysis of coping styles of patients could be a tool for professionals to manage properly the disease.
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Affiliation(s)
- Ana Torres-Ortuño
- Department of Psychiatry and Social Psychology, Faculty of Medicine, University of Murcia, Murcia, Spain
| | - Rubén Cuesta-Barriuso
- Department of Physiotherapy, School of Biomedical and Health Sciences, European University of Madrid, Madrid, Spain.,Royal Foundation Victoria Eugenia, Madrid, Spain
| | - Joaquín Nieto-Munuera
- Department of Psychiatry and Social Psychology, Faculty of Medicine, University of Murcia, Murcia, Spain
| | - Pilar Galindo-Piñana
- Department of Psychiatry and Social Psychology, Faculty of Medicine, University of Murcia, Murcia, Spain
| | - José Antonio López-Pina
- Department of Basic Psychology and Methodology, Faculty of Psychology, University of Murcia, Murcia, Spain
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16
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Yazicioglu I, Deveci C, Çiftçi V, Antmen B, Doğan MC. Parent’s report on oral health‐related quality of life of children with haemophilia. Haemophilia 2019; 25:229-235. [DOI: 10.1111/hae.13678] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 12/07/2018] [Accepted: 12/15/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Iffet Yazicioglu
- Department of Paediatric Dentistry Çukurova University Sarıçam, Adana Turkey
| | - Ceren Deveci
- Department of Paediatric Dentistry Çukurova University Sarıçam, Adana Turkey
| | - Volkan Çiftçi
- Department of Paediatric Dentistry Çukurova University Sarıçam, Adana Turkey
| | - Bülent Antmen
- Division of Haematology, Department of PaediatricsAcıbadem Hospital Adana Turkey
| | - Muharrem C. Doğan
- Department of Paediatric Dentistry Çukurova University Sarıçam, Adana Turkey
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17
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Attempting to remedy sub-optimal medication adherence in haemophilia: The rationale for repeated ultrasound visualisations of the patient's joint status. Blood Rev 2018; 33:106-116. [PMID: 30146094 DOI: 10.1016/j.blre.2018.08.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 07/14/2018] [Accepted: 08/17/2018] [Indexed: 01/01/2023]
Abstract
Haemophilia is marked by joint bleeding (haemarthrosis) leading to cartilage damage (arthropathy). Lifelong prophylaxis-initiated after the first bleeding episode-leads to a dramatic decrease in arthropathy in haemophilia patients. However, adherence to continuous intravenous administrations of factor VIII (FVIII) or FIX products is challenging, and patients potentially suffer from breakthrough bleedings while on prophylaxis. Newer FVIII/FIX products with enhanced convenience attributes and/or easier infusion procedures are intended to improve adherence. However, pharmacokinetic data should be harmonised with information from individual attitudes and treatment needs, to tailor intravenous dosing and scheduling in patients who receive extended half-life products. Nor is there sound evidence as to how subcutaneous non-FVIII/FIX replacement approaches (concizumab; emicizumab; fitusiran) or single intravenous injections of adeno-associated viral vectors (when employing gene therapy) will revolutionize adherence in haemophilia. In rheumatoid arthritis, repeated ultrasound examination of a patient's major joints is a valuable tool to educate patients and parents to understand the disease and provide an objective framework for clinicians to acknowledge patient's adherence. Joint ultrasound examination in haemophilia significantly correlates with cartilage damage, effusion, and synovial hypertrophy evaluated by magnetic resonance imaging. Furthermore, in patients with haemophilia undergoing prophylaxis with an extended half-life product for a ≈ 2.8 year period, a significant continued improvement in joint health is detected at the physical examination. This provides the rationale for studies on repeated ultrasound examinations of joint status to attempt to remedy sub-optimal medication adherence and help identify which approach is most suited on which occasion and for which patient.
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18
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Koeberlein-Neu J, Runkel B, Hilberg T. Cost-utility of a six-month programmed sports therapy (PST) in patients with haemophilia. Haemophilia 2018; 24:385-394. [PMID: 29600588 DOI: 10.1111/hae.13459] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2018] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Recurrent musculoskeletal haemorrhages in people with haemophilia (PwH) lead to restrictions in the locomotor system and, as a result, in physical performance, too. Due to its physical and psychological benefits, sport is increasingly re-commended for haemophilic patients. Evidence on the cost-effectiveness of sports therapy is still lacking. AIM The aim of this study was to determine the cost-effectiveness of a 6-month programmed sports therapy (PST). METHODS The cost-effectiveness of the 6-month PST was assessed from a societal perspective alongside a RCT using cost-utility analysis. The analysis included 50 PwH with moderate-to-severe haemophilia A and B and a training period over 6 months. The health-related quality of life was measured with the EuroQoL-domain questionnaire. Resource utilization was assessed by questionnaire before and after the intervention. A cost-effectiveness acceptability curve was constructed, and sensitivity analyses were performed. RESULTS During the 6-month study period, mean adjusted total healthcare costs were lower (mean difference: -22 805 EUR; 95%-CI: -73 944-48 463; P = .59) and the number of QALYs was higher in the intervention group (mean difference: 0.3733; 95%-CI: 0.0014-0.0573; P = .04). The probability of an incremental cost-effectiveness ratio <50 000 EUR per QALY was 71%. The performed sensitivity analysis confirmed these results. CONCLUSION Results showed that the PST is effective in terms of a significant gain of QALYs. Furthermore, results weakly indicate the potential of the PST to reduce healthcare costs. Future studies should expand the observation period to have a closer look at the influence of PST on lifetime costs.
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Affiliation(s)
- J Koeberlein-Neu
- Center for Health Economics and Health Services Research, University of Wuppertal, Wuppertal, Germany
| | - B Runkel
- Department of Sports Medicine, University of Wuppertal, Wuppertal, Germany
| | - T Hilberg
- Department of Sports Medicine, University of Wuppertal, Wuppertal, Germany
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19
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Machin N, Ragni MV. Measuring success in hemophilia gene therapy using a factor level & outcomes yardstick. Expert Rev Hematol 2018; 11:83-86. [DOI: 10.1080/17474086.2018.1423961] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Nicoletta Machin
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
- Hemophilia Center of Western Pennsylvania, Pittsburgh, PA, USA
| | - Margaret V. Ragni
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
- Hemophilia Center of Western Pennsylvania, Pittsburgh, PA, USA
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20
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Manco-Johnson MJ, Lundin B, Funk S, Peterfy C, Raunig D, Werk M, Kempton CL, Reding MT, Goranov S, Gercheva L, Rusen L, Uscatescu V, Pierdominici M, Engelen S, Pocoski J, Walker D, Hong W. Effect of late prophylaxis in hemophilia on joint status: a randomized trial. J Thromb Haemost 2017; 15:2115-2124. [PMID: 28836341 DOI: 10.1111/jth.13811] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Indexed: 11/29/2022]
Abstract
Essentials High-quality data are lacking on use of prophylaxis in adults with hemophilia and arthropathy. SPINART was a 3-year randomized clinical trial of late/tertiary prophylaxis vs on-demand therapy. Prophylaxis improved function, quality of life, activity and pain but not joint structure by MRI. Prophylaxis improves function but must start before joint bleeding onset to prevent arthropathy. SUMMARY Background Limited data exist on the impact of prophylaxis on adults with severe hemophilia A and pre-existing joint disease. Objectives To describe 3-year bleeding, joint health and structure, health-related quality-of-life (HRQoL) and other outcomes from the open-label, randomized, multinational SPINART study. Patients/Methods Males aged 12-50 years with severe hemophilia A, ≥ 150 factor VIII exposure days, no inhibitors and no prophylaxis for > 12 consecutive months in the past 5 years were randomized to sucrose-formulated recombinant FVIII prophylaxis or on-demand therapy (OD). Data collected included total and joint bleeding events (BEs), joint structure (magnetic resonance imaging [MRI]), joint health (Colorado Adult Joint Assessment Scale [CAJAS]), HRQoL, pain, healthcare resource utilization (HRU), activity, and treatment satisfaction. Results Following 3 years of prophylaxis, adults maintained excellent adherence, with a 94% reduction in BEs despite severe pre-existing arthropathy; 35.7% and 76.2% of prophylaxis participants were bleed-free or had fewer than two BEs per year, respectively. As compared with OD, prophylaxis was associated with improved CAJAS scores (least squares [LS] mean, - 0.31 [n = 42] versus + 0.63 [n = 42]) and HAEMO-QoL-A scores (LS mean, + 3.98 [n = 41] versus - 6.00 [n = 42]), less chronic pain (50% decrease), and approximately two-fold less HRU; activity, Euro QoL-5D-3L (EQ-5D-3L) scores and satisfaction scores also favored prophylaxis. However, MRI score changes were not different for prophylaxis versus OD (LS mean, + 0.79 [n = 41] versus + 0.96 [n = 38]). Conclusions Over a period of 3 years, prophylaxis versus OD in adults with severe hemophilia A and arthropathy led to decreased bleeding, pain, and HRU, better joint health, activity, satisfaction, and HRQoL, but no reduction in structural arthropathy progression, suggesting that pre-existing joint arthropathy may be irreversible.
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Affiliation(s)
| | - B Lundin
- Lund University and Skåne University Hospital, Lund, Sweden
| | - S Funk
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - C Peterfy
- Spire Sciences, Inc., Boca Raton, FL, USA
| | - D Raunig
- ICON Medical Imaging, Warrington, PA, USA
| | - M Werk
- Martin-Luther-Krankenhaus, Akademisches Lehrkrankenhaus der Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | - M T Reding
- University of Minnesota, Minneapolis, MN, USA
| | - S Goranov
- UMHAT Sveti Georgi and Medical University, Plovdiv, Bulgaria
| | | | - L Rusen
- S. C. SANADOR SRL, Bucharest, Romania
| | - V Uscatescu
- Institutul Clinic Fundeni, Bucharest, Romania
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21
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Gringeri A, Steinitz-Trost K, Doralt J. Current and future approaches to overcoming the challenges of hemophilia treatment personalization. Expert Opin Orphan Drugs 2017. [DOI: 10.1080/21678707.2017.1334551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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22
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McMullen S, Buckley B, Hall E, Kendter J, Johnston K. Budget Impact Analysis of Prolonged Half-Life Recombinant FVIII Therapy for Hemophilia in the United States. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2017; 20:93-99. [PMID: 28212975 DOI: 10.1016/j.jval.2016.09.2396] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 09/02/2016] [Accepted: 09/03/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Hemophilia A is a factor VIII deficiency, associated with spontaneous, recurrent bleeding episodes. This may lead to comorbidities such as arthropathy and joint replacement, which contribute to morbidity and increased health care expenditure. Recombinant factor VIII Fc fusion protein (rFVIIIFc), a prolonged half-life factor therapy, requires fewer infusions, resulting in reduced treatment burden. OBJECTIVE Use a budget impact analysis to assess the potential economic impact of introducing rFVIIIFc to a formulary from the perspective of a private payer in the United States. METHODS The budget impact model was developed to estimate the potential economic impact of adding rFVIIIFc to a private payer formulary across a 2-year time period. The eligible patient population consisted of inhibitor-free adults with severe hemophilia A, receiving recombinant-based episodic or prophylaxis treatment regimens. Patients were assumed to switch from conventional recombinant factor treatment to rFVIIIFc. Only medication costs were included in the model. RESULTS The introduction of rFVIIIFc is estimated to have a budget impact of 1.4% ($0.12 per member per month) across 2 years for a private payer population of 1,000,000 (estimated 19.7 individuals receiving treatment for hemophilia A). The introduction of rFVIIIFc is estimated to prevent 124 bleeds across 2 years at a cost of $1891 per bleed avoided. CONCLUSIONS Hemophilia A is a rare disease with a low prevalence; therefore, the overall cost to society of introducing rFVIIIFc is small. Considerations for comprehensively assessing the budget impact of introducing rFVIIIFc should include episodic and prophylaxis regimens, bleed avoidance, and annual factor consumption required under alternative scenarios.
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23
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Hermans C, Klamroth R, Richards M, de Moerloose P, Garrido RP. Outcome measures in European patients with haemophilia: Survey of implementation in routine clinical practice, perception of relevance and recommendations by European treaters in the EHTSB. Haemophilia 2016; 23:222-229. [PMID: 27790841 DOI: 10.1111/hae.13085] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2016] [Indexed: 11/28/2022]
Abstract
INTRODUCTION This study was conducted to evaluate the current implementation of outcome measures in routine clinical haemophilia practice and to explore and appreciate the perception of the relevance of such measures by treaters. METHODS A survey was completed by 19 of the 26 physicians involved in the European Haemophilia Therapy Strategy Board (EHTSB). Employing an extensive inventory of outcome measures used in patients with haemophilia, information was collected about the frequency of data collection and the subjective appreciation of their importance during clinic review. RESULTS The survey revealed that most treaters currently collect data that are mainly related to the haemostatic treatment (consumption of concentrates) and the bleeding symptoms (number and location of bleeds) in a non-uniform and non-standardized way. By contrast, functional, physical and quality of life scorings are rarely used and show considerable heterogeneity between treaters. Also, many disparities emerged between practice and perception, in particular quality of life data that are perceived as being important but for most of the time are not collected. CONCLUSIONS This survey represents, in our view, the first attempt to evaluate the actual utilization of outcome measures in haemophilia care. While the value of outcome measures is appreciated, they are not assessed regularly. Therefore, there is a need to include appropriate performance indicators (outcome measures) of haemophilia care in routine clinical practice. Consensus recommendations to provide a framework for achieving this aim are provided.
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Affiliation(s)
- C Hermans
- Haemostasis and Thrombosis Unit, Division of Haematology, Cliniques universitaires Saint-Luc, Catholic University of Louvain, Brussels, Belgium
| | - R Klamroth
- Klinik für Innere Medizin, Hämophiliezentrum, Vivantes-Klinikum in Friedrichhain, Berlin, Germany
| | - M Richards
- Paediatric Haematology Department, Children's Day Hospital, St James University Hospital, Leeds, UK
| | - P de Moerloose
- Départment de Medicine Interne, Unité d'Hémostase, Hôpital Cantonal, Geneva, Switzerland
| | - R P Garrido
- Unidad de Hemofilia, Hospital Virgen del Rocio, Seville, Spain
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24
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Recht M, Konkle BA, Jackson S, Neufeld EJ, Rockwood K, Pipe S. Recognizing the need for personalization of haemophilia patient‐reported outcomes in the prophylaxis era. Haemophilia 2016; 22:825-832. [PMID: 27581872 DOI: 10.1111/hae.13066] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2016] [Indexed: 01/19/2023]
Affiliation(s)
- M. Recht
- The Hemophilia Center Oregon Health & Science University Portland OR USA
| | - B. A. Konkle
- Division of Hematology Bloodworks NW and Department of Medicine University of Washington Seattle WA USA
| | - S. Jackson
- Division of Hematology Department of Medicine University of British Columbia Vancouver BC Canada
| | - E. J. Neufeld
- Dana‐Farber/Boston Children's Cancer and Blood Disorders Center Boston Hemophilia Center Boston MA USA
| | - K. Rockwood
- Division of Geriatric Medicine Dalhousie University Halifax Nova Scotia Canada
| | - S. Pipe
- Departments of Pediatrics and Pathology University of Michigan Ann Arbor MI USA
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25
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Osooli M, Berntorp E. Registry-based outcome assessment in haemophilia: a scoping study to explore the available evidence. J Intern Med 2016; 279:502-14. [PMID: 26999367 DOI: 10.1111/joim.12434] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Haemophilia is a congenital disorder with bleeding episodes as its primary symptom. These episodes can result in negative outcomes including joint damage, loss of active days due to hospitalization and reduced quality of life. Effective treatment, however, can improve the outcome. Registries have been used as a valuable source of information regarding the monitoring of treatment and outcome. The two main aims of this exploratory study were to establish which haemophilia registries publish peer-reviewed outcome assessment research and then to extract, classify and report the treatment outcomes and their extent of use in the retrieved registries. Using relevant keywords, we searched PubMed and Web of Science databases for publications during the period 1990-2015. Retrieved references were screened in a stepwise process. Eligible papers were original full articles on haemophilia outcomes that used data from a computerized patient database. Descriptive results were summarized. Of 2352 references reviewed, 25 full texts were eligible for inclusion in the study. These papers were published by 11 registries ranging from local to international in coverage. It is still relatively rare for registries to produce peer-reviewed publications about outcomes, and most that currently do produce such papers are located in Europe and North America. More information is available on traditional outcomes such as comorbidities and arthropathy than on health-related quality of life or the social and developmental impact of haemophilia on patients. Inhibitors, HIV and viral hepatitis are amongst the most commonly reported comorbidities. Research has focused more on factor consumption and less on hospitalization or time lost at school or work due to haemophilia. Haemophilia registries, especially those at the national level, are valuable resources for the delivery of effective health care to patients. Validated outcome measurement instruments are essential for the production of reliable and accurate evidence. Finally, such evidence should be communicated to physicians, patients, the public and health policymakers.
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Affiliation(s)
- M Osooli
- Department of Translational Medicine, Centre for Thrombosis and Haemostasis, Lund University and Skåne University Hospital, Malmö, Sweden
| | - E Berntorp
- Department of Translational Medicine, Centre for Thrombosis and Haemostasis, Lund University and Skåne University Hospital, Malmö, Sweden
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Butler RB, Cheadle A, Aschman DJ, Riske B, Senter S, McLaughlin KM, Young G, Ahuja S, Forsberg AD. National needs assessment of patients treated at the United States Federally-Funded Hemophilia Treatment Centers. Haemophilia 2015; 22:e11-7. [PMID: 26517156 DOI: 10.1111/hae.12810] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2015] [Indexed: 11/26/2022]
Abstract
AIM The National Hemophilia Program Coordinating Center, with the U.S. Regional Hemophilia Network conducted a national needs assessment of U.S. Hemophilia Treatment Center (HTC) patients. The objectives were to determine: (i) To what extent do patients report that they receive needed services and education; (ii) How well do the services provided meet their needs; and (iii) What are the patients' perspectives about their care. METHODS A survey was mailed to active patients of 129 HTCs. Respondents completed the anonymous surveys on line or returned them by mail. Questions focused on management and information, access and barriers to care, coping, resources, and transition. RESULTS Of 24 308 questionnaires mailed, 4004 (16.5%) were returned. Most respondents reported very few gaps in needed services or information and reported that services and information met their needs. Over 90% agreed or strongly agreed that care was patient-centred and rated HTC care as important or very important. Identified gaps included dietary advice, genetic testing, information on ageing, sexual health and basic needs resources. Minority respondents reported more barriers. CONCLUSION This survey is the largest assessment of the HTC population. Respondents reported that the services and information provided by the HTCs met their needs. Quality improvement opportunities include transition and services related to ageing and sexual health. Further investigation of barriers to care for minorities is underway. Results will help develop national priorities to better serve all patients in the US. HTCs.
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Affiliation(s)
- R B Butler
- The Children's Hospital of Philadelphia Hemostasis and Thrombosis Center, Philadelphia, PA, USA
| | - A Cheadle
- Center for Community Health and Evaluation, Seattle, WA, USA
| | - D J Aschman
- National Hemophilia Program Coordinating Center, Riverwoods, IL, USA
| | - B Riske
- University of Colorado Hemophilia and Thrombosis Center, Aurora, CO, USA
| | - S Senter
- Center for Community Health and Evaluation, Seattle, WA, USA
| | - K M McLaughlin
- Maternal and Child Health Bureau, Health Resources and Services Administration, Rockville, MD, USA
| | - G Young
- Hemostasis and Thrombosis Center, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - S Ahuja
- Rainbow Babies & Children's Hospital, Cleveland, OH, USA
| | - A D Forsberg
- National Hemophilia Program Coordinating Center, Riverwoods, IL, USA
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Experience with central venous access devices (CVADs) in the Canadian hemophilia primary prophylaxis study (CHPS). Haemophilia 2015; 21:469-76. [DOI: 10.1111/hae.12713] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2015] [Indexed: 11/26/2022]
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Pocoski J, Benjamin K, Michaels LA, Flood E, Sasane R. An overview of current trends and gaps in patient-reported outcome measures used in haemophilia. Eur J Haematol 2015; 93 Suppl 75:1-8. [PMID: 24966140 DOI: 10.1111/ejh.12323] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
AIM This review summarises the importance, recent progress and issues in measuring patient-reported outcomes (PROs) in haemophilia research. METHODS A critical review of recent advances and trends in measuring haemophilia-related PROs was conducted, using current regulatory guidelines and methodological recommendations to evaluate these instruments. RESULTS Although regulators, payers and policymakers increasingly consider the patient's perspective to be important in treatment decision-making, to date, few haemophilia intervention studies have meaningfully applied PRO endpoints. Condition-specific PRO instruments have been developed, but most are not fully validated; sensitivity to subgroup differences and changes over time is unclear. Generic PROs and instruments developed for other conditions have been used to measure health-related quality of life (HRQL) in haemophilia patients, but little evidence of their validity for this purpose exists. Haemophilia presents a number of challenges to developing valid, reliable and responsive PRO instruments, including the rarity of the disorder; necessitating research in multiple counties to attain sufficient sample size; the chronic nature of the condition; acute exacerbations of illness; age and geographical region variations with respect to treatment; differences in treatment regimens, range of disease severity and phenotypes; and changes in patients' perceived health status over time. Given that haemophilia begins at birth, the illness has an impact on the lives of caregivers, although the extent of the impact is largely unknown. CONCLUSIONS Patient perspectives are crucial to understanding the best and most cost-effective haemophilia treatment approaches. More research is needed on the ability of current disease-specific and generic PRO instruments to capture responsiveness to treatments over time and subgroup differences in outcomes. Inclusion of PROs in clinical trials is necessary to answer these questions.
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Polack B, Calvez T, Chambost H, Rothschild C, Goudemand J, Claeyssens S, Borel‐Derlon A, Bardoulat I, Maurel F, Woronoff‐Lemsi M. EQOFIX: a combined economic and quality‐of‐life study of hemophilia B treatments in France. Transfusion 2015; 55:1787-97. [DOI: 10.1111/trf.13016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 12/03/2014] [Accepted: 12/08/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Benoît Polack
- Department of HematologyUniversity Hospital, and CNRS UMR5525, Grenoble‐Alpes UniversityGrenoble France
| | - Thierry Calvez
- Sorbonne University, UPMC University of Paris 06, INSERM, UMR‐S 1136, Pierre Louis Institute of Epidemiology and Public HealthParis France
| | - Hervé Chambost
- APHMDepartment of Pediatric HematologyChildren Hospital La Timone, and INSERM, UMR 1062, Aix‐Marseille UniversityMarseille France
| | - Chantal Rothschild
- Regional Hemophilia CenterDepartment of HematologyUniversity Hospital Necker Enfants MaladesParis France
| | - Jenny Goudemand
- Department of Hematology‐TransfusionUniversity HospitalLille France
| | | | - Annie Borel‐Derlon
- Regional Hemophilia and VWD CenterUniversity Hospital, and INSERM U919Caen France
| | - Isabelle Bardoulat
- Department of Health Economics and Outcome ResearchIMS HealthLa Défense France
| | - Frédérique Maurel
- Department of Health Economics and Outcome ResearchIMS HealthLa Défense France
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Forsyth AL, Witkop M, Lambing A, Garrido C, Dunn S, Cooper DL, Nugent DJ. Associations of quality of life, pain, and self-reported arthritis with age, employment, bleed rate, and utilization of hemophilia treatment center and health care provider services: results in adults with hemophilia in the HERO study. Patient Prefer Adherence 2015; 9:1549-60. [PMID: 26604708 PMCID: PMC4631419 DOI: 10.2147/ppa.s87659] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION Severe hemophilia and subsequent hemophilic arthropathy result in joint pain and impaired health-related quality of life (HRQoL). Assessment of HRQoL in persons with hemophilia (PWH), including underlying factors that drive HRQoL differences, is important in determining health care resource allocation and in making individualized clinical decisions. AIM To examine potential associations between HRQoL, pain interference, and self-reported arthritis and age, employment, activity, bleed frequency, and hemophilia treatment center and health care professional utilization. METHODS PWH (age ≥18 years) from ten countries completed a 5-point Likert scale on pain interference over the previous 4 weeks, the EQ-5D-3L scale (mobility, usual activities, self-care, pain/discomfort, anxiety/depression) including a health-related visual analog scale (0-100, coded as an 11-point categorical response). RESULTS Pain interference (extreme/a lot) was higher in PWH aged >40 years (31%) compared to those aged 31-40 years (27%) or ≤30 years (21%). In an analysis of eight countries with home treatment, PWH who reported EQ-5D mobility issues were less likely to be employed (53% vs 79%, with no mobility issues). Median annual bleed frequency increased with worsening EQ-5D pain or discomfort. The percentage of PWH with inhibitors reporting visual analog scale scores of 80-90-100 was lower (20%) than those without inhibitors (34%). Median bleed frequency increased with pain. Globally, nurse and social worker involvement increased with disability and pain; physiotherapist utilization was moderate regardless of the extent of disability or pain. CONCLUSION Increased disability and pain were associated with increased age, lower employment, higher reported bleed frequency, and lower HRQoL.
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Affiliation(s)
- Angela L Forsyth
- BioRx, Cincinnati, OH, USA
- Correspondence: Angela L Forsyth, BioRx: REBUILD Hemophilia Program, 7167 E Kemper Road, Cincinnati, OH 45249, USA, Tel +1 856 669 8307, Fax +1 877 588 8470, Email
| | | | | | - Cesar Garrido
- Asociacion Venezolana para la Hemofilia, Caracas, Venezuela
| | - Spencer Dunn
- Center for Inherited Blood Disorders, Orange, CA, USA
| | | | - Diane J Nugent
- Children’s Hospital of Orange County, Center for Inherited Blood Disorders, Orange, CA, USA
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de Jager T, Pericleous L, Kokot-Kierepa M, Naderi M, Karimi M. The burden and management of FXIII deficiency. Haemophilia 2014; 20:733-40. [DOI: 10.1111/hae.12474] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2014] [Indexed: 11/27/2022]
Affiliation(s)
- T. de Jager
- Pharmerit International; AV Rotterdam the Netherlands
| | | | | | - M. Naderi
- Genetics of Non-Communicable Disease Research Center; Zahedan University of Medical Sciences; Zahedan Iran
| | - M. Karimi
- Haematology Research Centre; Shiraz University of Medical Sciences; Shiraz Iran
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Dolatkhah R, Fakhari A, Pezeshki MZ, Shabanlouei R, Tavassoli N, Gholchin M. Social determinants and health-related dimensions of quality of life in adult patients with haemophilia. Haemophilia 2013; 20:376-81. [DOI: 10.1111/hae.12321] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2013] [Indexed: 01/11/2023]
Affiliation(s)
- R. Dolatkhah
- Hematology and Oncology Research Center; Tabriz University of Medical Sciences; Tabriz Iran
| | - A. Fakhari
- Clinical Psychiatry Research Center; Tabriz University of Medical Sciences; Tabriz Iran
| | - M. Z. Pezeshki
- Department of Community Medicine; Program for Estimation of Pretest Probability; Tabriz University of Medical Sciences; Tabriz Iran
| | - R. Shabanlouei
- Hematology and Oncology Research Center; Tabriz University of Medical Sciences; Tabriz Iran
| | - N. Tavassoli
- Hematology and Oncology Research Center; Tabriz University of Medical Sciences; Tabriz Iran
| | - M. Gholchin
- Hematology and Oncology Research Center; Tabriz University of Medical Sciences; Tabriz Iran
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Khair K. Supporting adherence and improving quality of life in haemophilia care. ACTA ACUST UNITED AC 2013; 22:692. [DOI: 10.12968/bjon.2013.22.12.692] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Kate Khair
- Haemophilia, Great Ormond Street Hospital for Children NHS Foundation Trust, London
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