A global view on prophylaxis: possibilities and consequences.
Prophylactic infusion therapy, both primary and secondary, has proven of great benefit to patients with haemophilia, specifically those with severe disease or bleeding episodes and patterns that have lead to development of arthropathy. At this time, optimal outcome in patients with severe haemophilia has been proven achievable with primary prophylaxis initiated at an early age in a regimen of three times weekly or every other day for patients with factor VIII deficiency, and twice weekly for those with factor IX deficiency. Despite the demonstrated benefit of primary prophylaxis, this treatment regimen has not been uniformly adopted into clinical practice even in developed countries. In developing countries, where issues of allocation of precious health care resources are of paramount importance, access to adequate treatment for persons with haemophilia on a programme of on-demand therapy is not commonly available; the cost of primary prophylaxis, even with intermediate purity plasma-derived factor concentrates or plasma fractions such as cryoprecipitate, renders this treatment the exception rather than the rule.
Shapiro
A D
AD
Indiana Hemophilia and Thrombosis Center, Indianapolis 46260, USA. ashapiro@ihtc.org
D003362:Cost-Benefit Analysis; D003906:Developing Countries; D005164:Factor IX / Q000008:administration & dosage*; D005169:Factor VIII / Q000008:administration & dosage* / Q000191:economics; D006076:Government; D006467:Hemophilia A / Q000191:economics / Q000517:prevention & control*; D002836:Hemophilia B / Q000191:economics / Q000517:prevention & control*; D006801:Humans; D007262:Infusions, Intravenous; D007348:Insurance, Health; D018579:Patient Selection; D012042:Registries
D005169:Factor VIII; D005164:Factor IX