Blackwell Publishing Journal Backfiles 1879-2005
Summary. Our objective was to determine costs and trends in treating boys with severe haemophilia A before our centre routinely used prophylaxis.One reviewer extracted data from patient charts to determine resource consumption for 17 boys with severe haemophilia A from 1978 to 1998 at Toronto's Hospital for Sick Children. Resources included factor concentrate, doctors and health care professionals (physiotherapists/social workers), tests (laboratory, radiological and diagnostic) and hospitalizations. Subgroup analysis on those patients infected with HIV and/or hepatitis were also performed. Costs in Canadian Dollars were taken from standard lists and discounted at 3%.Total average cost (range) $62 292 (3339–121 738) per year patient−1; the largest fraction, $59 910 (3103–119 480), 96.2% was accounted for by factor VIII. Hospitalizations accounted for $1832 (0–5217) per patient year−1 including drugs, nursing care and stay. Doctor and health care professionals visits averaged $252 (36–462) and $72 (0–175) per patient year−1, laboratory and other tests cost $201 (22–377) and $26 (2–60) per patient year−1, respectively. The average number of bleeds was 12.9 (2.0–22.0) per patient year−1, decreasing since 1977 by 0.68 per patient year−1 (R2 = 0.56). Hospitalizations averaged 0.22 (0–4) per patient year−1, lasting 2.3 days. From 1984, hospitalizations decreased by 0.025 patient−1 year−1 (R2 = 0.76). Concurrently, the average treatment costs increased by $5456 patient−1 year−1 (R2 = 0.81). Clotting factor concentrate cost per patient increased by $5521 year−1 (R2 = 0.82). Patients with virally transmitted diseases had considerable higher costs.The cost per year was substantial. Costs increased with virally transmitted diseases. Number of bleeds and hospitalizations over the period of study decreased and costs increased because of factor use in secondary prophylaxis.
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