Cost of care higher for older, sicker hemophilia A patients: Study
Patients 19 and older cost more than children
Brazilian hemophilia A patients who are 19 or older had significantly higher median care costs per patient per year than younger patients, a study reported.
The study also revealed an increase in median costs for patients with more severe disease — that is, those who have less than 1% of normal activity of the clotting factor VIII (FVIII), which is affected in hemophilia A patients — relative to those with moderate disease (FVIII activity from 1% to 5% of normal levels).
“This study can support the establishment of more sustainable health policies according to the population characteristics,” the researchers wrote. The results were presented in the article “Cost of hemophilia A in Brazil: a microcosting study,” published in Health Economics Review.
Patients with hemophilia A have a deficiency in FVIII, resulting in excessive and prolonged bleeding. Hemophilia treatment often requires regular doctor visits, medications, hospitalization, and additional medical and surgical procedures.
Brazil has the fourth-largest population of individuals with this type of hemophilia, with approximately 13,000 affected individuals nationwide. Despite the prevalence of the disease, the related direct and indirect cost of patient care for hemophilia A in Brazil is unknown, according to the study’s authors. “Most economic analyses on hemophilia evaluate its burden in the healthcare system perspective focusing mainly on the high prices of the medications, such as the management of inhibitors,” while “studies of the complete care cycle for hemophilia and the relationship among patients’ characteristics and cost items [are] still lacking,” the team wrote.
Age as cost driver
To assess which clinical characteristics of hemophilia were cost drivers, a team of Brazilian researchers analyzed retrospective data from 140 patients with hemophilia A assisted at three blood centers in Brazil.
Data showed that the median cost per patient per year was 450,831 reals (about $82,069).
When patients were stratified according to age, differences emerged. The researchers looked at three groups: those 11 or younger (53 patients), those 12-18 (29 patients), and those 19 and older (58 patients).
Patients who were 19 or older had the highest median costs per patient per year, 718,969 reals ($130,881), followed by the 12- to 18-year-old group, with median costs per patient of 521,936 reals ($95,013). Patients with hemophilia A who were 11 or younger had the lowest median costs per patient, 299,320 reals ($54,488).
Of the 140 patients, 95.7% had severe disease (134 patients), defined as less than 1% of the normal activity of FVIII, while the remainder had moderate disease (six patients), defined as clotting FVIII activity between 1 to 5% of normal levels.
Disease severity was identified as a cost driver. The median cost per patient per year was higher in patients with severe hemophilia (488,947 reals, about $89,008) relative to patients with moderate disease severity (172,720 reals, about $31,442). It was also higher in older groups with severe hemophilia.
The researchers looked at other characteristics of hemophilia and its treatment — the presence of inhibitors (neutralizing antibodies against the clotting factor in replacement therapies, which can reduce the efficacy of treatment), bleedings, surgery, and hospitalizations — but none of these factors was identified as a significant cost driver.
The total expected financial burden of hemophilia A in Brazil is an estimated 5.19 billion reals per year ($944,787,237), the researchers wrote.
The study’s authors called for further research into “gaps in diagnosis access” so that future analyses could assess how earlier diagnoses affect cost and disease management.
“Generating information on costs and their origin facilitates the implementation of actions aimed at efficient resource utilization in disease management,” they wrote, “thus contributing to the efficiency of the [healthcare] system.”
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