The challenge arising from the cost of haemophilia care: an audit of haemophilia treatment at Auckland Hospital.
OBJECTIVE
To compare treatment patterns in adults and children with haemophilia and to estimate the financial impact of the changing practice of haemophilia care.


METHODS
A retrospective audit of replacement coagulation factor usage in all patients with haemophilia treated at the Auckland Haemophilia Centre during 2001.


RESULTS
A total of 69 males with haemophilia were included in the audit. Twelve children under 16 years old (nine on recombinant products) and six adults (all on plasma products) received prophylactic treatment. The remaining patients used treatment on demand. The cohort included eight patients with factor VIII inhibitors. The estimated cost of replacement products used was around 3 million dollars for the 23 children and 2.2 dollars million for the 46 adults.


CONCLUSIONS
Children with severe haemophilia are predominantly treated with recombinant products on regular prophylaxis, whereas adults are largely treated on demand with plasma-derived products. This is in line with international practice as regular prophylaxis has been shown to improve the quality of life for people with haemophilia and in the long term is cost effective. The problem in the short term is that prophylaxis is significantly more expensive than on-demand treatment. We estimate that the cost of replacement product will increase by at least 5% per annum as the children with haemophilia grow.
Haematology Department, LabPlus, Auckland Hospital, Auckland, New Zealand. PaulH@adhb.govt.nz
Paul
P
Harper
Mary
M
Brasser
Louise
L
Moore
Lochie
L
Teague
Lydia
L
Pitcher
Paul
P
Ockelford
D000328:Adult; D001779:Blood Coagulation Factors / Q000191:economics* / Q000627:therapeutic use; D002648:Child; D016527:Drug Costs / Q000706:statistics & numerical data*; D005164:Factor IX / Q000191:economics / Q000627:therapeutic use; D005169:Factor VIII / Q000191:economics / Q000627:therapeutic use; D015942:Factor VIIa / Q000191:economics / Q000627:therapeutic use; D006467:Hemophilia A / Q000188:drug therapy / Q000191:economics*; D002836:Hemophilia B / Q000188:drug therapy / Q000191:economics*; D006801:Humans; D008297:Male; D008485:Medical Audit; D009520:New Zealand; D011994:Recombinant Proteins / Q000191:economics / Q000627:therapeutic use
D001779:Blood Coagulation Factors; D011994:Recombinant Proteins; C025667:prothrombin complex concentrates; D005169:Factor VIII; D005164:Factor IX; D015942:Factor VIIa