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

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.

Keywords::

• Hemophilia
• Medication adherence
• Healthcare cost
• Hospitalization

Transparency

Declaration of funding

This project was funded by Biogen Idec.

Declaration of interest

EA and DM were consultants to Biogen Idec through Strategic Therapeutics, LLC for this project. SK is an employee of and holds equity in Biogen Idec. MW has no interests which might be perceived as posing a conflict or bias. JME peer reviewers on this manuscript have no relevant financial or other relationships to disclose. The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, or the US Government.

Acknowledgments

EA, DM, SK, and MW were all involved in the design of the research and writing and editing the manuscript. EA and DM were responsible for the analysis of the data.