Costs of Care in Hemophilia and Possible Implications of Health Care Reform

Abstract

Economic evaluation in health care is increasingly used to assist policy makers in their difficult task of allocating limited resources. The high cost of care, including that for clotting factor concentrates, makes hemophilia a potential target for cost-cutting efforts by health care payers. Although the appropriate management of hemophilia is key to minimizing and preventing long-term morbidity, comparative effectiveness studies regarding the relative benefit of different treatment options are lacking. Cost-of-illness (COI) analysis, which includes direct and indirect costs from a societal perspective, can provide information to be used in cost-effectiveness and other economic analyses. Quality-of-life assessment provides another methodology with which to measure outcomes and benefits of appropriate disease management. Health care reform has implications for individuals with hemophilia and their families through changes in payment, insurance coverage expansion, and health care delivery system changes that reward quality and stimulate cooperative, team-based care. Providers will benefit from the expansion of insurance coverage and some financial benefits in rural areas, and from the expansion of coverage for preventive services. Accountable care organizations will potentially change the way providers are paid and financial incentives under reform will reward high quality of care.

Restless legs syndrome and its relationship with anxiety, depression, and quality of life in cancer patients undergoing chemotherapy

“…As the person with hemophilia grows older, recurrent hemathroses and soft-tissue hematomas lead to severe arthropathy and joint contractures [8]. The resulting chronic pain and disability can have short-and long-term effects on physical, social, and emotional functioning [9,10], as well as direct and indirect costs such as the impact of hemophilia caregiving on work productivity [11][12][13][14]. Further, patients may develop hypersensitivity reactions to factor replacement products (i.e., inhibitors), which occurs in about 25% of hemophilia A patients and 5% in hemophilia B patients [3], although inhibitors are less prevalent in hemophilia B, they can be more clinically significant, and can develop into nephrotic syndrome [3].…”

A population pharmacokinetic model for perioperative dosing of factor VIII in hemophilia A patients

“…In the Netherlands, total annual costs of replacement therapy are estimated at more than 130 million euro and include costs for prophylactic and "on demand" treatment. [4][5][6][7] In the Canadian Hemophilia Registry, perioperative consumption amounts to 1%-3% of the total annual amount administered. 8 As we have reported earlier, coagulation factor plasma concentrations as recommended by National and International Guidelines are often exceeded in the perioperative setting to avoid lower plasma concentrations and a possibly higher bleeding risk, with additional costs.…”

Self-Reported Barriers to Hemophilia Care in People with Factor VIII Deficiency

“…The Affordable Care Act legislation may resolve some insurance barriers (eliminating lifetime caps, expanding insurance coverage, reducing annual spending limits, eliminating preexisting exclusions, and expanding eligibility for Medicaid). 16 It also increases payments to providers in rural areas and provides coverage for preventive services. 16 Because of the wide range of fınancial and professional resources potentially available to HTCs, these providers are in a unique position to assist people with hemophilia who experience barriers to accessing adequate health care.…”

“…16 It also increases payments to providers in rural areas and provides coverage for preventive services. 16 Because of the wide range of fınancial and professional resources potentially available to HTCs, these providers are in a unique position to assist people with hemophilia who experience barriers to accessing adequate health care.…”