Author(s)
Zheng-Yi Zhou, MS, Graduate Student1, Denise Globe, PhD, Director, Global Health Economics2, Megan Ullman, MA, MPH, HUGS Site PI3, Judith Baker, MHSA, Regional Administrative Director4, Marion Koerper, MD, Pediatric blood disorder specialist5, Femida Gwadry-Sridhar, BScPhm, MSc, PhD, Assistant Professor6, Joanne Wu, MS, Programmer Analyst1, Ann Forsberg, MA, MPH, Administrator Region I Hemophilia Program7, Amy Shapiro, MD, Medical director and Pediatric Hematologist8, Brandy Trawinski, LPN, Site Coordinator8, Natalie Duncan, MPH, Disease Management Program Director8, Kathleen A Johnson, PharmD, MPH, Associate Professor, Chair11University of Southern California, Los Angeles, CA, USA; 2 Amgen, Thousand Oaks, CA, USA; 3 Gulf States Hemophilia and Thrombophilia Center, Houston, TX, USA; 4 University of California, Los Angeles, Los Angeles, CA, USA; 5 University of California, San Francisco, San Francisco, CA, USA; 6 University of Western Ontario, London, ON, Canada; 7 New England Hemophilia Center, Worcester, MA, USA; 8 Indiana Hemophilia and Thrombosis Center, Indianapolis, IN, USA
OBJECTIVES Hemophilia is a costly chronic illness. Clotting factor accounts for over 70% of hemophilia costs. We examined health care utilization, factor use and costs in people with hemophilia A from six Hemophilia Treatment Centers in seven states. METHODS Data were obtained prospectively from interviews and chart reviews with 329 patients aged 2 to 65 years enrolled in the Hemophilia Utilization Group Study Part V-A(2005-2007). We analyzed one-year healthcare utilization (outpatient, emergency room visits, and hospitalization) and total cost of clotting factor dispensed. Factor cost was estimated using average sales price from Medicare Part B. We further examined the association between these variables and clotting factor infusion strategies (episodic(to treat a bleed) versus prophylactic (administrate multiple times each week)) in patients with severe hemophilia using Chi-square test for categorical variables or Wilcoxon rank-sum test for continuous variables. RESULTS Fifty percent of patients were adults; Mean age 9.7±4.5 years for children and 33.7±12.5 years for adults. Two-thirds of patients had severe hemophilia. 97% used clotting factor; 68% of severe patients infused prophylactically. 89% reported using health services at least once: 56% had a comprehensive visit(range:0-3); 31% a clinician visit(range:0-14); 23% saw a physical therapist(range:0-21). 19% had emergency room visits and 15% were hospitalized. Mean cost of clotting factor was $208,548(median:$232,831) per patient-year. In patients with severe hemophilia, average number of hospital days/patient-year was 8(3 for prophylaxis users versus 13 for episodic treatment users, p=0.14). Patients with severe hemophilia were less likely to have an emergency room visit if they were on prophylaxis(13% vs. 25%, p=0.047). Mean factor cost was $281,151 per patient-year(median:$224,856) for patients on prophylaxis versus $154,855(median:$126,148) for episodic treatment users(p<0.0001). CONCLUSIONS This study contributes to the growing evidence that prophylactic infusion of clotting factors, compared to episodic treatment, may be associated with decreased health care utilization, including emergency room visits and hospitalizations.
Conference/Value in Health Info
2009-05, ISPOR 2009, Orlando, FL, USA
Value in Health, Vol. 12, No. 3 (May 2009)
Code
PSY32
Topic
Economic Evaluation
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
Systemic Disorders/Conditions
