Medical costs and hospital utilization for hemophilia A and B urban inpatients in China: a national cross-sectional study

Abstract

Background Hemophilia care in mainland China has been greatly improved since the establishment of the Hemophilia Treatment Center Collaborative Network of China (HTCCNC), and most of drugs for hemophilia have been covered by basic medical insurance schemes. This study assesses whether medical costs and hospital utilization disparities exist between hemophilia A and hemophilia B urban inpatients in China and, second, whether the prescription of coagulation factor concentrates for hemophilia A and hemophilia B inpatients was optimal, from the third payer perspective. Methods We conducted a retrospective nationwide analysis based on a 5% random sample from claims data of China Urban Employees’ Basic Medical Insurance (UEBMI) and Urban Residents’ Basic Medical Insurance (URBMI) schemes from 2010 to 2016. Univariate analysis and multiple regression analysis based on a generalized linear model were conducted. Result A total of 487 urban inpatients who had hemophilia were identified, including 407 inpatients with hemophilia A and 80 inpatients with hemophilia B. Total medical cost for hemophilia B inpatients was significantly higher than for hemophilia A inpatients (USD 2912.81 versus USD 1225.60, P < 0.05), and hemophilia B inpatients had a significantly longer length of hospital stay than hemophilia A inpatients (9.00 versus 7.00, P < 0.05). Total medical costs were mostly allocated to coagulation factor products (76.86-86.68%), with coagulation factor cost of hemophilia B significantly higher than hemophilia A (P < 0.05). Both hemophilia cohorts utilized greatest amount of plasma-derived Factor VIII, followed by recombinant Factor VIII and prothrombin complex concentrates. Conclusions Patients with hemophilia B experienced significantly higher inpatient cost, coagulation factor cost and longer length of hospital stay than patients with hemophilia A. Our findings revealed the suboptimal use of coagulation factor concentrate drugs and a higher drug cost burden incurred by hemophilia B than hemophilia A inpatients. Our results call for efforts to strengthen drug regulatory management for hemophilia and to optimize medical insurance schemes according to hemophilia types.

Treatment Adherence and Health-Related Quality of Life in Patients with Hemophilia in Hong Kong

“…Although the overall association between adherence and HRQoL was not significant in the multivariable analysis, the benefits of treatment adherence in improving health and psychosocial outcomes in patients with hemophilia are well documented in the literature [ 15 , 17 , 18 , 31 , 48 ]. In addition to improving functional outcomes, one Chinese study also showed that the suboptimal use of coagulation factor concentrates was associated with higher direct medical cost and healthcare use [ 49 ]. The findings collectively underscore the importance of developing strategies to improve adherence and optimize usage of prophylactic treatment in this patient cohort.…”

Exploring Female Relatives of Patients with Hemophilia’ Awareness, Attitudes, and Understanding Towards Genetic Testing

“…Hemophilia imposes a significant burden on affected families, 30 , 31 and the cost of genetic testing may be a barrier to implementing screening. Most interviewees indicated that the cost of screening would be a constraint affecting their decision to participate in genetic testing: “Now, the most disturbing thing is that I can’t go to work because I have to look after my son, and thus lost my source of income, having no money to support myself to participate in genetic testing.…”

Current status of treatment and disease burden of a cohort of hemophilia B in China

“…The per patient factor cost calculated in this study was 46,990.8 CNY ($7283.7), and the median of 15,262.5 CNY ($2365.7) may be more representative due to the skewed distribution of the data. In a study of medical costs for urban hemophilia patients in China from 2010 to 2016 ( 16 ), the cost of coagulation factors for HB patients was 7,128.0 CNY ($1,104.9), and some difference between them may be due to the study being from a third-party payer perspective, including only inpatients, and having a small sample size ( n = 80). The total cost of factor IX drugs for only 341 patients amounted to 16,024,000 CNY ($2,483,763.5) a year.…”

“…However, most available studies (over 70%) on the burden of hemophilia in China did not distinguish between HA and HB or only targeted HA patients, and were conducted from a third-party perspective, analyzing direct treatment costs through health insurance system data. There is a lack of studies specifically focusing on patients with HB, where the sample size of hemophilia B patients is small or does not indicate the type of hemophilia ( 16 , 17 ).…”