OBJECTIVES:

In Algeria as in other countries in the region, the circumcision is a ritual and its surgical procedure is considered as routine. However, the circumcision for patients with haemophilia A contains multiple challenges:

As the pre surgery protocol requires to administer high level of coagulation factor VIII, there is a significant risk of inhibitors development.

If the patient is not diagnosed, there is a risk of haemorrhage which may lead to death.

The aim of this study is to assess the economic impact of the circumcision in patients with haemophilia A in Algeria.

METHODS:

A cross-sectional, multicenter cost-of-illness study was carried out in 6 centers across Algeria including a micro-costing study to assess the cost of circumcision in patients with haemophilia A. To collect data on circumcision protocols and resource utilization in the different centers, a questionnaire was developed and direct health care costs were assessed for the whole population, compared among groups, categorized by age and taking into account inhibitor development.

RESULTS:

Across the 6 centers, circumcision of 25 patients with haemophilia A per year were identified. We observed disparities of procedures and protocols for patients with haemophilia A which implies a disparity in term of cost for these patients:

It appears that a procedure of circumcision is less expensive (1.258€) with a lower risk to develop inhibitor for children of age < 9 months compared to children of age > 2 years (7140 € to 11.442€). In case of patients with inhibitors, the cost of circumcision can reach 15.690€

CONCLUSIONS:

The circumcision protocols differ across the different centers and regions in Algeria. This leads to different patient experiences and different costs to hospital budget. The disparities should be harmonized through a consensual national protocol. This would result in better cost management.