title: The value of early treatment in patients with haemophilia and inhibitors.
abstract: Development of inhibitors to infused factor concentrates represents a major clinical and economic challenge in the treatment of haemophilic patients. It has been shown that a delay in initiation of treatment leads to requirement of a larger number of injections to stop the bleeding but this has never been formally linked to costs associated with the bleeding. The objectives of this study were to assess the relationship between time to initiation of NovoSeven and total costs, number of doses administered and time to bleeding resolution in mild to moderate bleeding episodes. Data on time to treatment initiation, time to bleeding resolution and on all resource use related to the bleeding were extracted from medical records in Turkey for 129 bleeding episodes. Regression analysis was used to assess the impact of time to treatment on outcomes. Longer time to treatment initiation increased both total costs associated with the bleeding, the number of doses needed and the time to bleeding resolution. Treatment in hospital was associated with significantly longer time to treatment, higher costs and longer time to bleeding resolution as compared with home treatment or outpatient treatment. When controlling for other bleeding characteristics, the cost of bleedings treated in hospital was more than 150% higher. This study shows that treatment with NovoSeven should be initiated as soon as possible after the onset of bleeding in order to minimize costs and optimize outcomes. Home treatment reduces time to treatment initiation and also reduces costs related to the bleeding.
authors.affiliation: Department of Pediatric Hematology, Ege University Hospital, Ege Hemophilia Center, Izmir, Turkey. kaan.kavakli@ege.edu.tr
authors.forename: K
authors.initials: K
authors.lastname: Kavakli
authors.forename: A
authors.initials: A
authors.lastname: Yesilipek
authors.forename: B
authors.initials: B
authors.lastname: Antmen
authors.forename: S
authors.initials: S
authors.lastname: Aksu
authors.forename: C
authors.initials: C
authors.lastname: Balkan
authors.forename: D
authors.initials: D
authors.lastname: Yilmaz
authors.forename: A
authors.initials: A
authors.lastname: Kupesiz
authors.forename: I
authors.initials: I
authors.lastname: Sasmaz
authors.forename: P
authors.initials: P
authors.lastname: Lindgren
authors.forename: J
authors.initials: J
authors.lastname: Mesterton
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D015942:Factor VIIa / Q000191:economics* / Q000627:therapeutic use; D017048:Health Care Costs; D006467:Hemophilia A / Q000188:drug therapy / Q000191:economics*; D002836:Hemophilia B / Q000188:drug therapy / Q000191:economics*; D006470:Hemorrhage / Q000188:drug therapy / Q000191:economics*; D006801:Humans; D011994:Recombinant Proteins / Q000191:economics / Q000627:therapeutic use; D012044:Regression Analysis; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult
chemical_list: D011994:Recombinant Proteins; D015942:Factor VIIa