RESOURCE UTILIZATION IN HEMOPHILIACS TREATED IN EUROPE - RESULTS FROMTHE EUROPEAN STUDY ON SOCIOECONOMIC ASPECTS OF HEMOPHILIA CARE

The objectives of our study was to answer the following questions: (1) What are the socioeconomic costs and benefits of different haemophili a treatment strategies! (2) Which savings can be achieved through a co mprehensive care program? (3) How are haemophiliacs integrated into th eir social life? (4) What are the annual costs of treating haemophilia from a third party payer perspective? In this cross-sectional study, 840 consecutive haemophiliacs attending 16 haemophiliac treatment cent res in 10 European countries at were entered in the study. The followi ng six parameters were analysed: sociodemographic patient data, the ty pe of substitution (on demand or prophylaxis), transfusion-transmitted diseases, the functional joint status, quality of life as well as the total costs of therapy. Three kinds of substitution modalities were d istinguished: on demand therapy, pure and modified prophylaxis. The av erage number of medical visits, the average length of hospital stay, r egular drug therapy and the average number of days off work per bleedi ng joint were recorded from the medical charts as a basis for the subs equent assessment of the costs of therapy. The total study sample comp rised of 566 patients. Interestingly, statistically more significant ( P = 0.0005) patients were unemployed in the on-demand group (14%) than in the prophylaxis group (3.4%). There was a higher ratio of white co llar workers in the on-demand group as compared to the prophylaxis gro up and vice versa for blue collar workers. The distribution of blue co llar workers, clerk, self-employed persons, students and housemen were quite comparable between the patients of the on-demand and prophylact ic therapeutic regimen. The labor force participation rate was 55.2% i n the patients in the on demand and 59.3% in the patients in the modif ied prophylactic group. The labor force participation rate across all patients was 56%. Patients on demand therapy used on average 38.3 (med ian: 12.5) units/kg/week as compared to 68.6 (median: 6) units/kg/week in the prophylaxis group. The mean usage across all patients was 46.1 (median 19.7) units/kg/week. There were an average of 7.4 (median: 3) joint bleeds per patient across all patients during the 6-month obser vation period. In the on-demand group 8.8 (median: 5) joint bleeds wer e recorded versus 3.1 joint bleeds (median: 0) in the prophylactic gro up. This difference was statistically different (95% CI of difference: 4.33-7.07). Our data suggest that patients receiving prophylactic clo tting factor therapy require less additional health care resources, ma inly due to the reduction in the number of joint bleeds.