Costs and utilization of hemophilia A and B patients with and without inhibitors

Edward P Armstrong, Daniel C Malone, Sangeeta Krishnan, Maj Jacob Wessler

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Objective: To evaluate the health system costs among patients with hemophilia A and B with and without inhibitors over 5 years. Methods: This was a retrospective, observational study utilizing medical and pharmacy electronic medical records and administrative encounters/claims data tracking US patients between 2006-2011. Patients with diagnosis codes for hemophilia A and B were identified. Patients with inhibitors were characterized by utilization of bypassing agents activated prothrombin complex concentrate or factor VIIa on two or more distinct dates. Severity was classified as mild, moderate, or severe based on laboratory tests of clotting factor. Results: There were 160 hemophilia A patients and 54 hemophilia B patients identified. From this group, seven were designated as patients with inhibitors (five with hemophilia A and two with hemophilia B). Hemophilia A patients without inhibitors reported 65 (41.9%) as being severe, 19 (12.3%) as moderate, and 71 (45.8%) as mild. Hemophilia B patients without inhibitors reported nine (17.3%) had severe, 13 (25.0%) had moderate, and 30 (57.7%) had mild hemophilia. All patients with inhibitors had been hospitalized in the previous 5 years compared to 64 (41.3%) with hemophilia A without inhibitors and 22 (42.3%) with hemophilia B without inhibitors. The median aggregate cost per year (including factor and health resource use) was $325,780 for patients with inhibitors compared to $98,334 for hemophilia A patients without inhibitors and $23,265 for hemophilia B patients without inhibitors. Conclusions: The results suggest that, while the frequency of inhibitors within the hemophilia cohort was low, there was a higher frequency of hospitalizations, and the associated median aggregate costs per year were 3-fold higher than those patients without inhibitors. In contrast, hemophilia B patients experience less severe disease and account for lower aggregate yearly costs compared to either patients with hemophilia A or patients with inhibitors.

Original languageEnglish (US)
Pages (from-to)798-802
Number of pages5
JournalJournal of Medical Economics
Volume17
Issue number11
DOIs
StatePublished - Jan 11 2014

Fingerprint

Hemophilia B
Hemophilia A
Costs and Cost Analysis
Patient Identification Systems
Medical Electronics
Factor VIIa
Blood Coagulation Factors
Electronic Health Records
Health Resources

Keywords

  • Healthcare cost
  • Hemophilia
  • Hospitalization
  • Medication adherence

ASJC Scopus subject areas

  • Health Policy

Cite this

Costs and utilization of hemophilia A and B patients with and without inhibitors. / Armstrong, Edward P; Malone, Daniel C; Krishnan, Sangeeta; Wessler, Maj Jacob.

In: Journal of Medical Economics, Vol. 17, No. 11, 11.01.2014, p. 798-802.

Research output: Contribution to journalArticle

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abstract = "Objective: To evaluate the health system costs among patients with hemophilia A and B with and without inhibitors over 5 years. Methods: This was a retrospective, observational study utilizing medical and pharmacy electronic medical records and administrative encounters/claims data tracking US patients between 2006-2011. Patients with diagnosis codes for hemophilia A and B were identified. Patients with inhibitors were characterized by utilization of bypassing agents activated prothrombin complex concentrate or factor VIIa on two or more distinct dates. Severity was classified as mild, moderate, or severe based on laboratory tests of clotting factor. Results: There were 160 hemophilia A patients and 54 hemophilia B patients identified. From this group, seven were designated as patients with inhibitors (five with hemophilia A and two with hemophilia B). Hemophilia A patients without inhibitors reported 65 (41.9{\%}) as being severe, 19 (12.3{\%}) as moderate, and 71 (45.8{\%}) as mild. Hemophilia B patients without inhibitors reported nine (17.3{\%}) had severe, 13 (25.0{\%}) had moderate, and 30 (57.7{\%}) had mild hemophilia. All patients with inhibitors had been hospitalized in the previous 5 years compared to 64 (41.3{\%}) with hemophilia A without inhibitors and 22 (42.3{\%}) with hemophilia B without inhibitors. The median aggregate cost per year (including factor and health resource use) was $325,780 for patients with inhibitors compared to $98,334 for hemophilia A patients without inhibitors and $23,265 for hemophilia B patients without inhibitors. Conclusions: The results suggest that, while the frequency of inhibitors within the hemophilia cohort was low, there was a higher frequency of hospitalizations, and the associated median aggregate costs per year were 3-fold higher than those patients without inhibitors. In contrast, hemophilia B patients experience less severe disease and account for lower aggregate yearly costs compared to either patients with hemophilia A or patients with inhibitors.",
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