HEMOPHILIA HOME TREATMENT - ECONOMIC-ANALYSIS AND IMPLICATIONS FOR HEALTH-POLICY

This analysis describes the development of technology for home self-in fusion of factor VIII in the treatment of hemophilia and its clinical, economic, and social consequences, and uses the case study of such ho me care treatment to illustrate the potentials and pitfalls of formal economic analyses of programs to treat chronically ill children. A com prehensive review of all original data on hemophilia programs, their r elated costs, and outcomes, conducted from 1966 through 1993, examined the economic outcomes for two hypothetical cohorts, one aged 0-4 year s and the other aged 30-34 years. Including the measurement of treatme nt effects on the productivity of parental caregivers substantially in creases the benefit-cost relationship of an intervention directed at c hronically ill children. Increased economic productivity and societal return resulting from such a program for young adults exceeds those fo r a cohort of children, primarily due to assumptions related to discou nting. However, estimation of quality-adjusted life years favors the y ounger age cohort, since children survive for a longer period of time and with each year survived comes a higher quality of life. Unlike sim pler instances in which economic benefits can be shown to outweigh res ource costs, policy decisions concerning services for chronically ill children raise an additional set of complex analytic issues. Inclusion of the benefits in productivity experienced by family caregivers prov ides an important added dimension to such analyses. The development of cost-benefit or cost-effectiveness analyses of these programs illustr ates the importance of careful measurement of outcomes and explicit st atements of underlying assumptions. Such an analysis of home care for children with hemophilia therefore demonstrates both the strengths and the limitations of this approach.