Z Li1, J Wu2, Y Zhao3, R Liu2, K Li3, Y Zhou1, R Wu4, R Yang5, X Zhang6, S Lian7, Q Hu8, X Li9, J Gu10, R Zhou11, J Sun12, C Li13, W Xu14, M-C Poon15, J Xiao1. 1. Department of Pediatrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China. 2. School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, China. 3. Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China. 4. Department of Hematology, Beijing Children's Hospital, Capital Medical University, Beijing, China. 5. Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China. 6. Shandong Center of Hemophilia Diagnosis and Treatment, Jinan, China. 7. Department of Hematology, Dalian Municipal Central Hospital, Dalian Medical University, Dalian, China. 8. Department of Pediatric Hematology, Tongji Hospital, Tongji Medical College Huazhong, University of Science & Technology, Wuhan, China. 9. Department of Pediatric Hematology and Oncology, Chengdu Women and Children's Center Hospital, Chengdu, China. 10. Department of Hematology, Subei people's Hospital, Yangzhou, China. 11. Department of Hematology, Drum Tower Hospital, Nanjing University Medical School, Nanjing, China. 12. Department of Hematology, NanFang Hospital, Southern Medical University, Guangzhou, China. 13. Department of Hematology and Oncology, Shenzhen Children's Hospital, Shenzhen, China. 14. Department of Hematology, Children's Hospital, School of Medicine, Zhejiang University, Hangzhou, China. 15. Division of Hematology/Hematologic Malignancies, Department of Medicine, University of Calgary-Foothills Hospital, Southern Alberta Rare Blood and Bleeding Disorders Comprehensive Care Program, Calgary, Canada.
Abstract
OBJECTIVE: To explore the influence of medical insurance policy and charity assistance projects on the uptake and discontinuation of regular prophylaxis treatment in Chinese severe haemophilia A children. METHODOLOGY: This retrospective study was conducted on children with severe haemophilia A, who received FVIII prophylaxis treatment at 12 haemophilia centres in China from 1 November 2007 to 31 May 2013. RESULTS: The average duration of prophylaxis treatment received by haemophilia children significantly increased from 16.7 weeks in 2008 to 32.8 weeks in 2012 (P < .001). The main reason for prophylaxis acceptance included dissatisfaction with previous "on-demand" regimens, availability of improved local medical insurance policies and patient/family awareness of haemophilia. The main reason for subsequent discontinuation of prophylaxis was economic instability. The upper limit of insurance was up to RMB 150 000/y (~USD: 22 000/y) for 80.1% of the insured patients and would be sufficient to cover the continuous low-dose prophylaxis regimen. However, for many patients the burden of out-of-pocket copayment cost represented a risk for poor adherence to regular prophylaxis. In about two third of the patients, the annual out-of-pocket copayment cost amounted to >50% of their average annual disposable income. Many patients therefore required assistance from the charity assistance projects, but nonadherence remained prevalent. CONCLUSION: Medical insurance policy and charity assistance projects helped haemophilia children to accept and continue prophylaxis regimens. It was the proportion of the out-of-pocket copayment cost rather than the upper limit of insurance reimbursement that restricted long-term regular low-dose prophylaxis in China.
OBJECTIVE: To explore the influence of medical insurance policy and charity assistance projects on the uptake and discontinuation of regular prophylaxis treatment in Chinese severe haemophilia Achildren. METHODOLOGY: This retrospective study was conducted on children with severe haemophilia A, who received FVIII prophylaxis treatment at 12 haemophilia centres in China from 1 November 2007 to 31 May 2013. RESULTS: The average duration of prophylaxis treatment received by haemophiliachildren significantly increased from 16.7 weeks in 2008 to 32.8 weeks in 2012 (P < .001). The main reason for prophylaxis acceptance included dissatisfaction with previous "on-demand" regimens, availability of improved local medical insurance policies and patient/family awareness of haemophilia. The main reason for subsequent discontinuation of prophylaxis was economic instability. The upper limit of insurance was up to RMB 150 000/y (~USD: 22 000/y) for 80.1% of the insured patients and would be sufficient to cover the continuous low-dose prophylaxis regimen. However, for many patients the burden of out-of-pocket copayment cost represented a risk for poor adherence to regular prophylaxis. In about two third of the patients, the annual out-of-pocket copayment cost amounted to >50% of their average annual disposable income. Many patients therefore required assistance from the charity assistance projects, but nonadherence remained prevalent. CONCLUSION: Medical insurance policy and charity assistance projects helped haemophiliachildren to accept and continue prophylaxis regimens. It was the proportion of the out-of-pocket copayment cost rather than the upper limit of insurance reimbursement that restricted long-term regular low-dose prophylaxis in China.
Authors: Zhengwei Huang; Stephen Nicholas; Yong Yang; Xiaoping Chen; Elizabeth Maitland; Yong Ma; Xuefeng Shi Journal: BMC Health Serv Res Date: 2022-02-19 Impact factor: 2.655