Abstract
Abstract Background hemophilia is a rare coagulopathy, treated by replacing the missing blood clotting factor. Objective to assess the direct costs of hemophilia treatment from the perspective of the Unified Health System, highlighting the impact costs of new therapeutic modalities. Method partial economic assessment of the direct costs of hemophilia, in which were collected data from patient records from 2011 to 2015, at the Blood Center in the city of Juiz de Fora. Costs were assigned to consultations, exams, hospitalizations, and medications according to the price list of the National Health Surveillance Agency (in Portuguese ANVISA) and the Table of Procedures, and Medications. Results among 98 patients evaluated, 76 had hemophilia A, and 43.3% presented severe hemophilia. The number of consultations and the consumption of Clotting Factor Concentrates (CFCs) were higher in severe hemophilia. Hospitalizations were rare. Direct costs increased 286.8% from 2011 to 2015. The mean annual cost per patient was R$57,416.43, with no significant difference between hemophilia A and B. The expenditures for factor concentrates amounted to 99.46% of total costs. The actual impact cost was more than R$6,000,000.00. Conclusion the direct costs of hemophilia were high, mainly due to factor concentrates. There was an increase in costs with the incorporation of technologies, although there are some areas with potential inefficiencies.
Highlights
IntroductionCongenital hemophilia is a Rare Bleeding Disorder (RBD) (incidence: 1 in 10,000-30,000 male births), affecting male individuals, almost exclusively, whose pathophysiology is related to the deficiency or abnormality of blood coagulation factor VIII activity (in hemophilia A) or factor IX activity (in hemophilia B)
Congenital hemophilia is a Rare Bleeding Disorder (RBD), affecting male individuals, almost exclusively, whose pathophysiology is related to the deficiency or abnormality of blood coagulation factor VIII activity or factor IX activity
The objective of this study was to evaluate the evolution of the direct medical costs of the treatment of individuals with hemophilia according to the SUS perspective, between 2011 and 2015, highlighting the real impact costs in a blood center of Southeastern Brazil
Summary
Congenital hemophilia is a Rare Bleeding Disorder (RBD) (incidence: 1 in 10,000-30,000 male births), affecting male individuals, almost exclusively, whose pathophysiology is related to the deficiency or abnormality of blood coagulation factor VIII activity (in hemophilia A) or factor IX activity (in hemophilia B). In its severe forms, bleeding may be spontaneous, affecting any organ or tissue, but especially the joints[1]. The treatment of hemophilia is based on replacement of the deficient clotting factor, which can be done in order to control bleeding (episodic treatment) or to prevent it (prophylaxis)[3]. Prophylaxis, when initiated early, is potentially capable of preventing arthropathy, deficiencies, and disabilities, and is considered the “gold standard treatment” for children with severe hemophilia[1]. When arthropathy already exists, prophylaxis cannot reverse it, but it seems to decrease its progression and reduce pain, inflammation, and number of bleeding episodes, being able to maintain patient mobility, reduce absenteeism at school or at work, and improve quality of life[4,5]
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