Hemophilia. Treatment of patients with inhibitors: cost issues.

The management of bleeding episodes and surgery in haemophilia patients who develop inhibitors is specially difficult and also has major impact on therapeutic costs. We assessed the costs of coagulation factors in noninhibitor haemophilia A and B patients (0 Inh; n=103), patients with low responding inhibitors (LR; n=24), patients with high responding inhibitors (HR; n=17) in our centre between 1988 and 1998 during two periods: 1988-1995 and 1996-1998, before and after the introduction of recombinant factor VIIa in France (1996). From 1988 to 1995 the mean annual cost of 0 inh and LR patients was 43 234 and 49 422, respectively, with more than 90% as home treatment, whereas the mean cost of HR patients was 56 262 (1.3 time more than 0 Inh), half of this cost being related to treatment administered in hospital. From 1996 to 1998, the mean cost of HR patients was 186 482, approximately three times more than that of 0 Inh (59 887) and LR patients (54 226) with half of the cost due to treatment administered in hospital. So rFVIIa seems to exert a major economic effect on both the cost of home treatment and treatment administered in hospital. It must be pointed out that particularly severe bleeding episodes were effectively treated with rFVIIa during this period and that rFVIIa allowed surgery to be undertaken: including two elective orthopaedic surgeries. So there is no doubt that rFVIIa offers new perspectives in the therapeutic management of HR patients, but creates a new economic situation which needs further evaluation.