title: Clinical and cost implications of target joints in Canadian boys with severe hemophilia A.
abstract: 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).
  
  
  METHODS
  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.
authors.affiliation: Division of Hematology/Oncology, The Hospital for Sick Children, Ontario, Canada.
authors.forename: Melissa
authors.initials: M
authors.lastname: Kern
authors.forename: Victor
authors.initials: V
authors.lastname: Blanchette
authors.forename: Ann Marie
authors.initials: AM
authors.lastname: Stain
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Einarson
authors.forename: Brian M
authors.initials: BM
authors.lastname: Feldman
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005169:Factor VIII / Q000191:economics; D005500:Follow-Up Studies; D017048:Health Care Costs; D006395:Hemarthrosis / Q000191:economics* / Q000209:etiology; D006403:Hematologic Tests / Q000191:economics; D006467:Hemophilia A / Q000150:complications*; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D012720:Severity of Illness Index
chemical_list: D005169:Factor VIII