title: Total knee arthroplasty in a patient with hemophilic arthropathy and high-titer inhibitors: a cost analysis.
abstract: A patient with hemophilia A, who developed factor VIII inhibitors and initially had funding for his total knee arthroplasty declined, is discussed. A total of £1 542 000 (US $2 474 603) was spent on medical treatment for recurrent hemarthroses over a 4-year period, while funding was sought. In comparison, the total cost for his knee arthroplasty was £542 858 (US $871 084) including perioperative recombinant clotting factors. Postoperatively, with 1-year follow-up, no further hemoarthroses have occurred; his analgesic requirement is significantly reduced; he has a much improved level of function; and treatment costs are significantly reduced, leading to a substantial overall saving. Our findings suggest that surgical treatment is beneficial and cost-effective for patients with hemophilia with inhibitors. Hospitals should not deny operative treatment based on cost alone.
authors.affiliation: Department of Orthopaedics, Cambridge University Hospital, CB2 0QQ, Cambridge, UK.
authors.forename: Jason M
authors.initials: JM
authors.lastname: Ali
authors.forename: Alan J
authors.initials: AJ
authors.lastname: Howieson
authors.forename: Kingsley
authors.initials: K
authors.lastname: Lawrence
authors.forename: Dipti
authors.initials: D
authors.lastname: Chitnavis
authors.forename: Jai
authors.initials: J
authors.lastname: Chitnavis
mesh_terms: D000328:Adult; D018771:Arthralgia / Q000209:etiology* / Q000601:surgery*; D019645:Arthroplasty, Replacement, Knee / Q000191:economics*; D003362:Cost-Benefit Analysis; D005169:Factor VIII / Q000037:antagonists & inhibitors*; D005500:Follow-Up Studies; D017048:Health Care Costs; D006395:Hemarthrosis / Q000150:complications* / Q000453:epidemiology; D006467:Hemophilia A / Q000150:complications*; D006801:Humans; D015994:Incidence; D007719:Knee Joint / Q000601:surgery; D008297:Male; D016896:Treatment Outcome
chemical_list: C078147:F8 protein, human; D005169:Factor VIII