Hospital Stays With Hemophilia More Costly Than US Average

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by Patricia Inacio PhD |

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Healthcare costs of a hospitalization for children and adults with hemophilia in the U.S. are higher than for those who do not have a bleeding disorder, a study reported.

Hospitalizations for children with hemophilia were also seen to be mostly driven by bleeding and catheter-related infections, while high blood pressure and other age-related conditions were the main cause of hospitalizations in adults.

A greater effort is needed to address these conditions to lower healthcare costs, the researchers noted.

The study, “Associated comorbidities, healthcare utilization & mortality in hospitalized patients with haemophilia in the United States: Contemporary nationally representative estimates,” was published in the journal Haemophilia.

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People with hemophilia A and B lack specific blood clotting factors, which are key proteins that prevent excessive bleeding. While factor VIII (FVIII) is missing or is defective in people with hemophilia A, factor IX (FIX) levels are low in those with hemophilia B.

Patients require medications and frequent doctor visits, hospitalizations, and medical and surgical procedures.

To assess the burden of in-hospital care and healthcare utilization patterns for adults and children with hemophilia living in the U.S., a team led by researchers at the Simmons Cancer Institute at SIU School of Medicine, in Illinois, analyzed data from the 2017 Nationwide Inpatient Sample (NIS). NIS is the largest publicly available database for all-payer inpatient discharges in the U.S.

Researchers reviewed entries in which hemophilia was either the main diagnosis leading to a hospital admission, or among a patient’s diagnosed conditions at the time of admission or during the hospital stay.

They identified 10,555 hospitalizations (18.3% children and 81.7% adults) in which hemophilia was one of the diagnoses. Of these, 8,690 were related to hemophilia A and 1,975 to hemophilia B; another 110 patients were categorized as having both hemophilia A and B. In 1,465 of the cases, hemophilia (either A or B) was the main diagnosis.

Adults’ median age at admission was 54, and 4 years old for children. Most patients were Caucasian (64.4%) and male (72.7%).

Urgent medical procedures were the most common reason for hospital admissions (82.1%). People with hemophilia were more likely to be treated at large hospitals (62.5%), with care primarily being conducted at urban teaching hospitals (82.9%).

Most admissions were due to high disease severity accompanied by marked loss of function, as measured by the All Patient Diagnosis Related Groups (APDRG). This general hospital classification system notes illness severity and likely outcomes, including mortality risk.

Major loss of function was found in 73.2% of hospitalized hemophilia patients and extreme loss in 22%. A total of 745 patients (7.1%) were classified at highest mortality risk according to APRDRG.

In adults with hemophilia, high blood pressure was the most common co-occurring disease (33.4%), followed by high cholesterol (23.6%), and type 2 diabetes (21.1%).

Other disorders included acute anemia due to blood loss (14.4%), heart disease (14.3%), congestive heart failure (12.4%), generalized infection (sepsis; 10.6%), and blood infection (2.1%). Infection by HIV and AIDS were found in 6.2 %, and hepatitis C in 14.6% of admissions.

“Interestingly, neither intracranial haemorrhage nor hemarthrosis [joint bleeds] was reported in adults top 10 most common diagnoses ” the researchers wrote.

For children, the most common co-occurring disorders were joint bleeds (11.4%), contusions (9.6%), and blood infection (9.3%). Complications due to the use of a catheter were seen in 3.9% of admissions.

The overall mortality rate for hospitalized patients with hemophilia was 2.3%. Respiratory failure was the main cause of mortality (67.3%), followed by acute renal failure (65.3%), and sepsis (49%).

Almost all hospitalized hemophilia patients had medical insurance (93.5%): 37.5% had Medicare, 27.9% Medicaid, and 28.1% were privately insured.

The median length of a hospital stay per hemophilia patient was three days, which was similar to all hospital stays (also three days).

Median hospital charges per admission due to hemophilia were $52,616, which was higher than hospital charges due to all-causes ($26,841).

Overall, these findings show that the “costs for haemophilia-related hospitalizations are higher than the national average for all-cause hospitalizations,” the researchers noted.

“The high cost of care as revealed in this study underscores the continued need for efforts to reduce the health care expenses,” they wrote, “specifically the cost of haemophilia therapeutics for patients and the health care system.”

However, the researchers also noted that median hospital care costs for hemophilia patients in 2007 was $76,823 using NIS data — higher than the overall cost seen with the 2017 database. They suggested this drop could be due to greater “adherence to outpatient prophylaxis regimens,” shorter hospital stays, and better outpatient services like physical therapy.

“Future efforts in paediatric [hemophilia patients] should focus on early recognition of bleeding events and complications,” they wrote, adding that for adults the focus should be in “prevention of age-related comorbidities such as cardiovascular disease, to reduce the healthcare burden.”