Related Experiment Videos
Clinical and cost implications of target joints in Canadian boys with severe hemophilia A
Melissa Kern1, Victor Blanchette, Ann Marie Stain
1Division of Hematology/Oncology, The Hospital for Sick Children, Ontario, Canada.
Insights
Developing a target joint significantly increases healthcare costs for boys with severe hemophilia A. Proactive treatment strategies are crucial to mitigate these rising expenses and improve patient outcomes.
Area of Science:
- Pediatric Hematology
- Orthopedic Surgery
- Health Economics
Background:
- Severe hemophilia A can lead to target joint development, characterized by recurrent bleeds into a single joint.
- Target joints significantly impact patient morbidity and healthcare resource utilization.
Purpose of the Study:
- To compare the costs associated with target joint development in boys with severe hemophilia A.
- Analyze cost differences 1 year before and 1 year after the onset of a target joint.
Main Methods:
- Retrospective analysis of resource utilization data for 16 boys with severe hemophilia A.
- Data extracted from medical charts, hemophilia clinic records, and patient diaries.
- Costs calculated based on standard prices, with a 3% annual discount rate.
Main Results:
- Fifteen of 16 boys developed at least one target joint, most commonly in the ankle.
- Total treatment costs increased by 119% after target joint development, from $20,091 to $43,890 (2002 CAD).
- Factor VIII (FVIII) use constituted the majority of costs (87% pre-TJ, 93% post-TJ).
Conclusions:
- Target joint development in severe hemophilia A is associated with substantial increases in healthcare costs.
- Findings support early prophylactic therapy or more aggressive management of joint bleeds to prevent target joints.
- Cost-effectiveness of early intervention strategies warrants further investigation.
Objective:
To compare target joint-associated costs incurred by boys with severe hemophilia A 1 year before and 1 year after development of a target joint (pre-TJ, post-TJ).
Study Design:
Resource utilization data were extracted retrospectively from medical and hemophilia clinic charts and patient diaries for 16 boys attending the Hospital for Sick Children (HSC)'s comprehensive care hemophilia program. Resources examined included drugs, medical care, hospitalization, laboratory tests, therapies, and transfusions received. All costs were figured using standard price lists and were discounted using an annual rate of 3%.
Results:
Fifteen of the 16 boys developed at least one target joint, defined as three bleeds into any single joint within a consecutive 3-month period, at an average age of 54 months (range, 15-94 months), with ankles being most often affected, followed by elbows and knees (46% vs 28% and 23%, respectively). The total cost of treating a boy with on-demand Factor VIII (FVIII) increased by 119% after development of a target joint, from $20,091 (in 2002 Canadian dollars [$CDN]) in the year before to $43,890 in the year after target joint development. Factor VIII use accounted for 87% of the total cost in the year before target joint development and 93% in the year after.
Conclusions:
This study identified substantial increased costs of care associated with target joint development. This finding provides further support for more aggressive treatment aimed at reducing target joints-either more aggressive treatment of joint bleeds or institution of primary prophylactic therapy at an early age.
Related Concept Videos
01:21Rheumatic Heart Disease III: Medical Management
01:22Rheumatic Heart Disease II: Clinical Manifestations and Diagnostic Studies
01:24Disorders of Hemostasis
Thromboembolic Disorders
Two factors primarily cause thromboembolic conditions.
01:20Venous Thrombosis II: Clinical Manifestations and Diagnostic Studies