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Davari M, Sadeghi A, Gharibnaseri Z, Ravanbod R, Eshghi P, Zargaran M. An efficient and effective ambulatory service model for severe hemophilia-A patients; an introduction to a novel home care model. AMERICAN JOURNAL OF BLOOD RESEARCH 2021; 11:520-527. [PMID: 34824884 PMCID: PMC8610799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 08/09/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Hemophilia A (HA) is an inherited deficiency in blood coagulation factors. Starting the treatment based merely on patients' hemorrhage feelings results in more than 63.6% mistakes in joint bleeding diagnosis. This study aimed to design a useful ambulatory service model for Patients With Severe Hemophilia A (PWSHA). METHODS This study was done in 3 steps. In step-I, the current service model to PWSHA in Tehran was evaluated. In step II, an ambulatory service model was proposed according to the existed gaps and their requirement. In step III, the model's acceptability was assessed from the perspective of clinicians, PWSHA, and healthcare policymakers. RESULTS There were 1660 PWSHA in Tehran in 2018. The average use of Factor VIII (FVIII) was 44814 IU in Iran. The yearly budget of FVIII in Tehran was 10,627,320 US$ in 2018. We proposed a home care model with five care centers in Tehran. Ten caregivers and three hematologists for each care center were suggested to cover all services per day. The extracted data indicated that the total service demand would be 39 for each center per day. The results of the questionnaires in all groups were supportive and cooperative. CONCLUSION The current service delivery model to PWSHA has significant economic and clinical defects. Implementing our model can significantly improve the efficiency of bleeding management in PWSHA. Most of the PWSHA, healthcare managers, and clinicians were satisfied with the proposed model.
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Affiliation(s)
- Majid Davari
- Department of Pharmacoeconomics and Pharmaceutical Administration, Faculty of Pharmacy, Tehran University of Medical SciencesTehran, Iran
- Health Equity Research Centre, Tehran University of Medical SciencesTehran
| | - Abolfazl Sadeghi
- Department of Pharmacoeconomics and Pharmaceutical Administration, Faculty of Pharmacy, Tehran University of Medical SciencesTehran, Iran
| | - Zahra Gharibnaseri
- Department of Pharmacoeconomics and Pharmaceutical Administration, Faculty of Pharmacy, Tehran University of Medical SciencesTehran, Iran
| | - Roya Ravanbod
- School of Medical Sciences, Tarbiat Modares UniversityTehran, Iran
| | - Peyman Eshghi
- Shahid Beheshti University of Medical Sciences Department of PediatricsTehran, Iran
| | - Marziyeh Zargaran
- Department of Pharmacoeconomics and Pharmaceutical Administration, Faculty of Pharmacy, Tehran University of Medical SciencesTehran, Iran
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Hsieh MHC, Chiou SS, Liao TC, Kao Yang YH, Lai ECC. Trends in coagulation factor replacement therapy and medical costs in patients with haemophilia in Taiwan: A population-based, 15-year analysis. Haemophilia 2021; 27:e187-e193. [PMID: 33550710 DOI: 10.1111/hae.14250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 12/18/2020] [Accepted: 12/28/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Taiwan's National Health Insurance Program approved reimbursement of prophylactic coagulation factor replacement therapy (CFRT) for patients with haemophilia (PWH) in 2014. AIM To examine 15-year trends and the impact of reimbursement for prophylactic CFRT on its utilization and related medical costs for PWH. METHODS We analysed Taiwan's National Health Insurance Database from 2003 to 2017. We included patients with haemophilia A (PWHA) or B (PWHB) receiving coagulating factor. Female patients were excluded because of small sample size. We analysed annual consumption of CFRT units and medical costs. High proportion of days covered (PDC) with CFRT served as an indicator for prophylactic treatment since it reflects routine use of CFRT. We applied interrupted time series analysis (ITSA) to evaluate the impact of reimbursement for prophylactic CFRT on usage patterns and medical costs. RESULTS We included 896 male PWHA and 181 male PWHB, with 38.1% and 37.0% aged under 18 years, respectively. By ITSA, we found the trends in coagulation factor consumption and PDC significantly increased after reimbursement for prophylactic CFRT in both PWHA and PWHB (p values for trend change <0.05). The overall medical costs per patient increased with increasing consumption of coagulation factor; however, ITSA revealed non-CFRT cost decreased after reimbursement of prophylactic CFRT for both PWHA and PWHB (p values <.05). CONCLUSION Reimbursement for prophylactic CFRT facilitated growth in rates of prophylactic CFRT and increased related costs, but curbed rising non-CFRT costs. These findings provide strong grounds for future cost-effectiveness studies to leverage prophylactic CFRT for its therapeutic benefits.
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Affiliation(s)
- Miyuki Hsing-Chun Hsieh
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Shyh-Shin Chiou
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Tzu-Chi Liao
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yea-Huei Kao Yang
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Health Outcome Research Center, National Cheng Kung University, Tainan, Taiwan
| | - Edward Chia-Cheng Lai
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Health Outcome Research Center, National Cheng Kung University, Tainan, Taiwan.,Department of Pharmacy, National Cheng Kung University Hospital, Tainan, Taiwan
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Okide CC, Eseadi C, Koledoye UL, Mbagwu F, Ekwealor NE, Okeke NM, Osilike C, Okeke PM. Challenges facing community-dwelling adults with hemophilia: Implications for community-based adult education and nursing. J Int Med Res 2020; 48:300060519862101. [PMID: 31311372 PMCID: PMC7140222 DOI: 10.1177/0300060519862101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Community-dwelling adults are members of society residing in community settings.
Community-based adult education is designed for local residents and groups, to
enable them to improve their quality of life within their community. Hemophilia
is a bleeding disorder that can be inherited or acquired. World Hemophilia Day
2018 helped to raise awareness about the importance of sharing knowledge and the
experience of hemophilia, as well as to improve access to care and treatment
among people with this bleeding disorder. We used the documentary method of
research, which has been adopted in recent review articles, to collect and
analyze the findings of published literature on hemophilia. Our results showed
that community-dwelling adults with hemophilia have concerns that merit the
attention of government and non-governmental agencies. Some challenges faced by
many community-dwelling adults with hemophilia include the cost of treatment and
employment challenges. Herein, we discuss the implications for community-based
health education and nursing with respect to patient care, adult education,
nursing education, management, research, and policy. Finally, the authors note
that sustainable efforts are needed in the provision of local, national and
international leadership and educational resources to improve and sustain health
care for community-dwelling adults with hemophilia.
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Affiliation(s)
- Charity Chinelo Okide
- Department of Adult Education and Extra-Mural Studies,
University of Nigeria, Nsukka, Enugu State, Nigeria
| | - Chiedu Eseadi
- Department of Educational Foundations, University of Nigeria,
Nsukka, Enugu State, Nigeria
| | - Uzoamaka Lucynda Koledoye
- Department of Adult Education and Extra-Mural Studies,
University of Nigeria, Nsukka, Enugu State, Nigeria
| | - Felicia Mbagwu
- Department of Adult Education and Extra-Mural Studies,
University of Nigeria, Nsukka, Enugu State, Nigeria
- Felicia Mbagwu, Department of Adult
Education and Extra-Mural Studies, University of Nigeria, Nsukka, P.M.B. 410001,
Enugu State, Nigeria.
| | - Nwakaego Ebele Ekwealor
- Department of Adult Education and Extra-Mural Studies,
University of Nigeria, Nsukka, Enugu State, Nigeria
| | - Nkechi Mercy Okeke
- Department of Adult Education and Extra-Mural Studies,
University of Nigeria, Nsukka, Enugu State, Nigeria
| | - Chioma Osilike
- Department of Adult Education and Extra-Mural Studies,
University of Nigeria, Nsukka, Enugu State, Nigeria
| | - Polycarp M.D. Okeke
- Department of Adult Education and Extra-Mural Studies,
University of Nigeria, Nsukka, Enugu State, Nigeria
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Feldman BM, Rivard GE, Babyn P, Wu JKM, Steele M, Poon MC, Card RT, Israels SJ, Laferriere N, Gill K, Chan AK, Carcao M, Klaassen RJ, Cloutier S, Price VE, Dover S, Blanchette VS. Tailored frequency-escalated primary prophylaxis for severe haemophilia A: results of the 16-year Canadian Hemophilia Prophylaxis Study longitudinal cohort. LANCET HAEMATOLOGY 2018; 5:e252-e260. [PMID: 29731369 DOI: 10.1016/s2352-3026(18)30048-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 03/24/2018] [Accepted: 03/27/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Severe haemophilia A has high morbidity, and treatment, while effective, is very expensive. We report the 16-year follow-up of the Canadian Hemophilia Prophylaxis Study, which examined the effectiveness of tailored frequency-escalated primary prophylaxis with a focus on health outcomes within the domains of body structures and functions, and activities and participation (according to the WHO International Classification of Functioning, Disability and Health [WHO-ICF] framework) and a view to reducing consumption of costly clotting factor, which accounts for more than 90% of the cost of care of severe haemophilia. METHODS In this longitudinal study, boys with severe haemophilia A from 12 Canadian centres were enrolled at age 1·0-2·5 years. They were treated with standard half-life recombinant factor VIII (SHL-rFVIII), beginning as once-weekly prophylaxis with 50 IU/kg and escalating in frequency (with accompanying dose adjustments) in response to breakthrough bleeding as determined by the protocol. The primary endpoint for this analysis was joint health, as measured by the modified Colorado Child Physical Examination Scores (CCPES) at study end. All analyses were done by intention to treat. The trial is complete, and is registered with ClinicalTrials.gov, number NCT01085344. FINDINGS Between June 26, 1997, and Jan 30, 2007, 56 boys were enrolled. They were followed for a median of 10·2 years (to a maximum of 16·1 years). Median rFVIII usage was about 3600 IU/kg per year. The median end-of-study CCPES physical examination score was 1 (IQR 1-3; range 0-12) for the left ankle and 1 (1-2; 0-12) for the right ankle, with all other joints having a median score of 0. No treatment-related safety events occurred over the duration of the study, including central venous catheter infections. The median annualised index joint bleeding rate was 0·95 per year (IQR 0·44-1·35; range 0·00-13·43), but 17 (30%) patients had protocol-defined unacceptable breakthrough bleeding at some point during the study. INTERPRETATION Tailored frequency-escalated prophylaxis leads to very little arthropathy and very good health outcomes within the WHO-ICF domains, and only uses a moderate amount of expensive clotting factor as compared with standard prophylaxis protocols. Some sequelae of bleeding were observed in our cohort, and future studies should consider a more stringent protocol of escalation. FUNDING This study was initially funded by grants from the Medical Research Council of Canada/Pharmaceutical Manufacturers Association of Canada Partnership Fund and the Bayer/Canadian Blood Services/Hema-Quebec Partnership Fund. Subsequent renewals were funded by Bayer.
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Affiliation(s)
- Brian M Feldman
- Division of Rheumatology, The Hospital for Sick Children, Toronto, ON, Canada; Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, ON, Canada; Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management & Evaluation, the Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
| | - Georges E Rivard
- Division of Hematology/Oncology, Department of Pediatrics, CHU Sainte-Justine, Montreal, QC, Canada
| | - Paul Babyn
- Department of Medical Imaging, University of Saskatchewan, Saskatoon, SK, Canada
| | - John K M Wu
- Division of Hematology/Oncology/BMT, Department of Pediatrics, UBC & BC Children's Hospital, Vancouver, BC, Canada
| | - MacGregor Steele
- Section of Pediatric Hematology, Alberta Children's Hospital, Calgary, AB, Canada
| | - Man-Chiu Poon
- Department of Medicine, Division of Hematology and Hematologic Malignancies, Foothills Hospital, Calgary, AB, Canada
| | - Robert T Card
- Department of Hematology, Division of Oncology, University of Saskatchewan, Saskatoon, SK, Canada
| | - Sara J Israels
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
| | - Nicole Laferriere
- Division of Hematology/Oncology, Thunder Bay Regional Cancer Care, Thunder Bay, ON, Canada
| | - Kulwant Gill
- Hemophilia Program, Laurentian Hospital, Sudbury, ON, Canada
| | - Anthony K Chan
- Department of Pediatrics, McMaster Children's Hospital, McMaster University, Hamilton, ON, Canada
| | - Manuel Carcao
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada; Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, ON, Canada; Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Robert J Klaassen
- Department of Pediatrics, University of Ottawa, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Stephanie Cloutier
- Centre de l'hémophilie de l'est du Québec de Québec-Hôpital de l'Enfant-Jésus, Université Laval, Quebec, QC, Canada
| | - Victoria E Price
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, IWK Health Centre, Dalhousie University, Halifax, NS, Canada
| | - Saunya Dover
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, ON, Canada
| | - Victor S Blanchette
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada; Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, ON, Canada; Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Modified Primary Prophylaxis in Previously Untreated Patients With Severe Hemophilia A in Iran. J Pediatr Hematol Oncol 2018; 40:188-191. [PMID: 29356759 DOI: 10.1097/mph.0000000000001082] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Recently the low-dose tailoring method of primary prophylaxis has been introduced for previously untreated patients with hemophilia A. OBJECTIVE To evaluate the efficacy and safety of low-dose tailoring method of primary prophylaxis in previously untreated patients with severe hemophilia A. MATERIALS AND METHODS In this pre-post interventional study, 33 patients with severe hemophilia A who were previously untreated and affiliated to universities in the capital city and southern Iran were evaluated during 2014 to 2015. Modified primary continuous prophylaxis was used for patients with age below 3 years old, after first and before the second episodes of obvious clinical bleeding in large joints or large soft tissue hematoma or large amount of bleeding. Prophylaxis was started by 25 IU/kg once per week and increased to twice or 3 times a week according to defined bleeding events. RESULTS The median age at diagnosis and age of starting prophylaxis were: 4 months (at birth, 22 mo) and 12 months (1 to 35 mo), respectively. Mean annual bleeding rate of patients after prophylaxis was 1.08±2.21 episodes per year. None of the patients had inhibitors before therapy. Inhibitor was present in 5 patients (15.1%) after prophylaxis. CONCLUSIONS It seems that modified primary continuous prophylaxis has been successful in reducing bleeding episodes in children with severe hemophilia A and in the texture of lower cost it can improve quality of life of these patients, especially in developing countries where financial resources are limited.
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Coppola A, D'Ausilio A, Aiello A, Amoresano S, Toumi M, Mathew P, Tagliaferri A. Cost-effectiveness analysis of late prophylaxis vs. on-demand treatment for severe haemophilia A in Italy. Haemophilia 2017; 23:422-429. [DOI: 10.1111/hae.13185] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2017] [Indexed: 11/26/2022]
Affiliation(s)
- A. Coppola
- Regional Reference Centre for Coagulation Disorders; Federico II University Hospital Naples; Naples Italy
| | | | | | | | - M. Toumi
- Aix-Marseille University; Marseille France
| | | | - A. Tagliaferri
- Regional Reference Centre for Inherited Bleeding Disorders; University Hospital of Parma; Parma Italy
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Drummond M, Houwing N, Slothuus U, Giangrande P. Making economic evaluations more helpful for treatment choices in haemophilia. Haemophilia 2017; 23:e58-e66. [DOI: 10.1111/hae.13173] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2016] [Indexed: 01/25/2023]
Affiliation(s)
- M. Drummond
- Centre for Health Economics; University of York; York UK
| | - N. Houwing
- Pharmerit Europe; Rotterdam The Netherlands
| | | | - P. Giangrande
- University of Oxford, Green Templeton College; Oxford UK
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8
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Mullins ES, Stasyshyn O, Alvarez-Román MT, Osman D, Liesner R, Engl W, Sharkhawy M, Abbuehl BE. Extended half-life pegylated, full-length recombinant factor VIII for prophylaxis in children with severe haemophilia A. Haemophilia 2016; 23:238-246. [DOI: 10.1111/hae.13119] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2016] [Indexed: 11/28/2022]
Affiliation(s)
- E. S. Mullins
- Cincinnati Children's Hospital Medical Center; Cincinnati OH USA
| | - O. Stasyshyn
- SI Institute of Blood Pathology and Transfusion Medicine of NAMSU; Lviv Ukraine
| | | | - D. Osman
- Hospital Tengku Ampuan Rahimah; Klang Selangor Malaysia
| | - R. Liesner
- Great Ormond Street Hospital for Children; London UK
| | - W. Engl
- Baxalta Innovations GmbH, now part of Shire; Vienna Austria
| | - M. Sharkhawy
- Baxalta Innovations GmbH, now part of Shire; Vienna Austria
| | - B. E. Abbuehl
- Baxalta Innovations GmbH, now part of Shire; Vienna Austria
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Gringeri A, Doralt J, Valentino LA, Crea R, Reininger AJ. An innovative outcome-based care and procurement model of hemophilia management. Expert Rev Pharmacoecon Outcomes Res 2016; 16:337-45. [PMID: 27074697 DOI: 10.1080/14737167.2016.1178066] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Hemophilia is a rare bleeding disorder associated with spontaneous and post-traumatic bleeding. Each hemophilia patient requires a personalized approach to episodic or prophylactic treatment, but self-management can be challenging for patients, and avoidable bleeding may occur. Patient-tailored care may provide more effective prevention of bleeding, which in turn, may decrease the likelihood of arthropathy and associated chronic pain, missed time from school or work, and progressive loss of mobility. A strategy is presented here aiming to reduce or eliminate bleeding altogether through a holistic approach based on individual patient characteristics. In an environment of budget constraints, this approach would link procurement to patient outcome, adding incentives for all stakeholders to strive for optimal care and, ultimately, a bleed-free world.
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Affiliation(s)
| | | | - Leonard A Valentino
- b Baxalta U.S., Inc ., Bannockburn , IL , USA.,c Rush University , Chicago , IL , USA
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