Cost-effectiveness of prophylaxis against on-demand treatment in boys with severe hemophilia A in Iran.
OBJECTIVE
The aim of this study was to assess the incremental cost-effectiveness of on-demand versus prophylactic hemophilia therapy in Iran from a third-party payers' perspective.


METHODS
A retrospective chart review of twenty-five type A hemophiliacs who were treated in three hemophilia treatment centers was conducted. The patients were boys 0-9 years old receiving one of two treatments: (i) prophylaxis with concentrate at clinic; (ii) concentrate at clinic as on-demand. Fourteen boys received on-demand infusions for bleeding events, and eleven boys received infusions prophylaxis. Data were extracted from documents in the hemophilia treatment centers during a period of approximately 6 months.


RESULTS
The patients receiving prophylactic treatment had fewer bleeding events each month (mean, 0.26 versus 2.74) but used more concentrate (225.31 versus 87.20 units/kg per month). Average monthly cost per patient in the prophylaxis group was approximately 1.9 times higher than in the on-demand group. Compared with on-demand infusion, prophylaxis costs 3,201,656 Rials (euro213.45) per bleeding event prevented.


CONCLUSIONS
Prophylactic care markedly reduces the number of bleeding episodes, but at considerable cost.
Health Care Management, Shiraz University of Medical Sciences, Department of Health Insurance, Ministry of Welfare and Social Security, Tehran, Iran. alik2003@gmail.com
Aliasghar Ahmad Kia
AA
Daliri
Hassan
H
Haghparast
Jahanara
J
Mamikhani
D002648:Child; D002675:Child, Preschool; D003029:Coagulants / Q000008:administration & dosage* / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D004334:Drug Administration Schedule; D005169:Factor VIII / Q000008:administration & dosage* / Q000191:economics* / Q000627:therapeutic use; D006467:Hemophilia A / Q000188:drug therapy* / Q000191:economics*; D006801:Humans; D007492:Iran; D008297:Male; D012189:Retrospective Studies; D012720:Severity of Illness Index
D003029:Coagulants; D005169:Factor VIII