title: Determinants of drug costs in hopitalised patients with haemophilia: impact of recombinant activated factor VII.
abstract: OBJECTIVE
  To analyse the determinants of anti-haemophilic drug costs in hospitalised patients with haemophilia and to estimate the impact of recombinant activated factor VII (rFVIIa) therapy on this expenditure.
  
  
  CONCLUSIONS
  The perspective of the study was from the viewpoint of the hospital.
  
  
  METHODS
  A prospective study was carried out. All patients with haemophilia who were hospitalised in 1999 in Bicêtre public hospital, Paris, France were included in the cohort.
  
  
  RESULTS
  For each of the 96 patients (154 hospital stays), we estimated the costs of anti-haemophilic drugs (coagulation concentrates) used. Costs were then stratified by different variables (severity of the disease, presence of a circulating inhibitor to coagulation factors, etc.) and a multivariate model was developed to determine the relationship between these variables and total anti-haemophilic drug costs, while controlling for potential confounders. Our study revealed: (i) the independent role of the five following variables in contributing to high anti-haemophilic drug expenditure: presence of a circulating inhibitor to coagulation factors, odds ratio (OR) = 16.9 (95% CI: 4.3-66); severity of the disease (factor VIII or factor IX < or =0.01 IU/mL), OR = 3.7 (95% CI: 1.6-8.6); length of hospital stay >4 days, OR = 8 (95% CI: 2.2-29.4); age >18 years old, OR = 6.2 (95% CI: 1.6-24.5); and surgical reasons for hospitalisation (whether surgery was haemophilia related [OR = 35.7 (95% CI: 7.3-175)] or not [OR = 5.4 (95% CI: 1.3-22.5)]); (ii) the large share that rFVIIa represented in this expenditure on medicines: rFVIIa was used in 20.1% of hospital stays and accounted for 56.2% of the total anti-haemophilic drug costs, which were estimated at 4,384,732 Euros (2000 values).
  
  
  CONCLUSIONS
  Our data underline the heavy cost of the treatment of haemophilic patients with an inhibitor to coagulation factors. But, to the question of whether the high expenditure linked to rFVIIa utilisation will be balanced out by later benefits, it is not yet possible to reply with any certainty; further cost-benefit evaluation should be carried out.
authors.affiliation: INSERM U537, Center for Health Economics and Administration Research, Bicêtre Hospital, Paris, France.
authors.forename: Jean Philippe
authors.initials: JP
authors.lastname: Galanaud
authors.forename: Nathalie
authors.initials: N
authors.lastname: Pelletier-Fleury
authors.forename: Hélène
authors.initials: H
authors.lastname: Logerot-Lebrun
authors.forename: Thierry
authors.initials: T
authors.lastname: Lambert
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D016527:Drug Costs / Q000706:statistics & numerical data*; D015942:Factor VIIa / Q000191:economics* / Q000627:therapeutic use; D005260:Female; D006467:Hemophilia A / Q000188:drug therapy* / Q000191:economics*; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006779:Hospitals, Public / Q000191:economics*; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D010297:Paris; D011446:Prospective Studies; D011994:Recombinant Proteins / Q000191:economics / Q000627:therapeutic use
chemical_list: D011994:Recombinant Proteins; D015942:Factor VIIa