Hemophilia A drives healthcare costs higher, says study in Canada

Hemophilia A patients rack up high hospital bills, driving costs for the healthcare system higher, a study from Canada showed.

“This study confirms that even with improved [treatment to reduce bleeding], hemophilia A has a non-negligible impact on healthcare system costs,” researchers wrote in the study, “Population-Level Real-World Healthcare Costs in Men and Women With Haemophilia A,” which was published in Haemophilia.

They said their findings “will support future comparisons between current treatments and upcoming novel therapies.”

Hemophilia A is a bleeding disorder marked by a deficiency of factor VIII, a protein that normally helps blood to clot. In most cases, hemophilia A is caused by mutations in the gene that encodes this clotting protein. The gene is located on the X chromosome, one of the two sex-determining chromosomes.

Hemophilia A predominantly affects boys and men, though girls and women also can have the condition. Studies estimate that up to one in 10 people with the disease is female. “There is a sustained push for increased inclusion of women with hemophilia within research studies,” the researchers noted. They said their study is “one of the first population-based studies of hemophilia A to investigate sex-based differences in cost.”

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Aiming for a comprehensive understanding

Medical care for people with hemophilia A commonly requires special consideration to prevent and control bleeding. This can lead to increased healthcare costs. However, there’s only been one study evaluating how hemophilia A affects healthcare costs in Canada — and that study was limited to children at a single center, making it difficult to generalize the findings to the broader population of Canadians with hemophilia A.

The researchers set out to get a more comprehensive understanding of how hemophilia A affects medical costs in Canada by leveraging databases across the province of Ontario. The team focused on costs related to hospitalizations or emergency department visits, or to joint replacement operations. Joint problems are common in hemophilia due to bleeding in the joints.

They compared data from 2,341 people with hemophilia A (1,722 male, 619 female) with data from demographically similar people without hemophilia. Results showed that, when there was no major joint damage, the average 30-day cost was $910 for females with hemophilia A and $724 for males with hemophilia A. By contrast, among individuals without hemophilia, average costs were lower: $469 for females and $352 for males.

Healthcare costs for people with hemophilia A were significantly higher when there was substantial joint damage and in the months immediately following joint replacement surgery. In fact, costs were consistently higher for both male and female hemophilia patients in nearly all timepoints studied, with the lone exception of costs in the year before death for male patients.

“Overall, the total costs were generally higher for people with hemophilia A than for those without, excluding the pre-death phase where males without hemophilia A had higher costs than males with hemophilia A,” the researchers concluded.

In statistical models, the researchers found that healthcare costs increased with age among female hemophilia A patients, but not their male counterparts.

The researchers said their estimates for hemophilia A-related healthcare costs in Canada are lower than similar estimates that have been done in the U.S. This “could be due to the unique healthcare structure of the United States,” the researchers wrote.

“The discrepancies between the most recent results from the US indicate the need for Canadian healthcare system-based studies to ensure that Canadian policy decisions are made with up-to-date data reflecting the realities of the Canadian healthcare system,” they added.