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Insurance, home therapy, and prophylaxis in U.S. youth with severe hemophilia

Judith R Baker1, Brenda Riske, Mariam Voutsis

  • 1Department of Pediatric Hematology/Oncology, University of California Los Angeles, Los Angeles, California 90095, USA. judithbaker@mednet.ucla.edu

American Journal of Preventive Medicine
|November 22, 2011
PubMed

Insights

Health insurance is linked to prophylaxis treatment in severe hemophilia patients, but not home infusion therapy. Private insurance is associated with higher prophylaxis use compared to Medicaid or no insurance.

Area of Science:

  • Pediatric Hematology
  • Health Services Research
  • Public Health

Background:

  • Home infusion therapy and prophylaxis regimens reduce morbidity in severe hemophilia.
  • The relationship between insurance coverage and home infusion therapy for hemophilia is not well understood.

Purpose of the Study:

  • To investigate the associations between insurance status, home infusion therapy, and prophylaxis in a large cohort of severe hemophilia patients.
  • To analyze data from 3380 boys and young men (2-20 years) treated at 129 hemophilia treatment centers (HTCs) in the U.S.

Main Methods:

  • Multiple regression analysis was employed to assess the independent associations of risk factors, including insurance, with home infusion and prophylaxis.
  • Data were collected from January 1, 2008, to December 31, 2010, and analyzed in 2011.

Main Results:

  • Ninety percent of patients received home therapy, and 78% used prophylaxis; only 2% were uninsured.
  • Health insurance was significantly associated with prophylaxis use, but not home therapy.
  • Lower prophylaxis rates were linked to Medicaid, "other" insurance, or no insurance compared to private insurance.

Conclusions:

  • The U.S. hemophilia treatment center network demonstrates high rates of health insurance, home therapy, and prophylaxis among youth with severe hemophilia.
  • Further research is needed to understand factors influencing insurance coverage and HTC utilization.
  • Interventions to improve home infusion and prophylaxis are warranted for specific racial/ethnic groups.
Abstract

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