Patients’, physicians’, and pharmacists’ preferences towards coagulation factor concentrates to treat haemophilia with inhibitors: results from the COHIBA Study

Abstract

Despite modern highly efficacious technologies, there is still a lack of consensus on how to optimally treat haemophilia patients with inhibitors. The aim of the study was to evaluate preferences towards the characteristics of different coagulation factor concentrates for haemophilia inhibitors patients, from the perspective of patients or their caregivers, haematologists and pharmacists. A discrete choice study was conducted. Potential products were described with eight selected characteristics: perceived viral safety, risk of anamnestic response, possibility of undergoing major surgery, frequency of infusions in prophylaxis, number of infusions to stop bleeding, time to stop bleeding, time to pain recovery and cost. Participants received 16 pairs of potential products and chose from each pair the option they considered better. Data were analysed with a random-effects conditional logistic model. Totally 1614 observations were obtained from 37 patients/caregivers, 39 physicians and 25 pharmacists from Italy. Cost was the most important characteristic to every group. For patients/caregivers, the next most important factors were: risk of anamnestic response, possibility of undergoing major surgery and perceived viral safety. For physicians, the next most important characteristics were: risk of anamnestic response, number of infusions to stop bleeding and possibility of undergoing major surgery. For pharmacists, the next most important factors were: time to stop bleeding, time to pain recovery and possibility of undergoing major surgery. Decisions on treatments must take into account patients clinical needs; however, preferences can also play an important role in the choice and success of treatments. The results of this study could, therefore, help decision-makers to optimize the overall benefits of treatments.

Physician preferences for medication attributes for the prophylactic treatment of patients with severe haemophilia A with inhibitors to factor VIII

“…In contrast, in another previous study that examined Italian patients', pharmacists' and physicians' preferences for medication attributes for the treatment of uncomplicated haemophilia, cost and perceived viral safety were the most important considerations for physicians . A similar study of Italian physicians' pharmacists' and patients' preferences for the treatment of patients with inhibitors also found that cost, which was defined as an increase in health care taxes, was the most important attribute to physicians (RI = 25.7%) . Among inhibitor patients (or their caregivers) in this same study, cost (RI = 21.0%), risk of anamnestic response (RI = 20.3%), possibility of undergoing major surgery (RI = 17.9%) and perceived viral safety (RI = 17.7%) were the most important characteristics .…”

“…A similar study of Italian physicians' pharmacists' and patients' preferences for the treatment of patients with inhibitors also found that cost, which was defined as an increase in health care taxes, was the most important attribute to physicians (RI = 25.7%) . Among inhibitor patients (or their caregivers) in this same study, cost (RI = 21.0%), risk of anamnestic response (RI = 20.3%), possibility of undergoing major surgery (RI = 17.9%) and perceived viral safety (RI = 17.7%) were the most important characteristics . However, consistent with the current study, characteristics related to patient convenience such as the dosage form and frequency of infusions, were of relatively minor importance to both patients and physicians in each of these previous studies .…”

“…Previous studies have examined preferences among patients, pharmacists and physicians for on‐demand use of medications in patients with inhibitors. The results of these studies suggest that the preferences and opinions of these groups differ for on‐demand treatment for both uncomplicated haemophilia A and for treatment of patients who have developed inhibitors . A previous conjoint analysis (CA) of physicians examining their preferences for coagulation factor concentrates specifically in the on‐demand treatment of patients with inhibitors found that efficacy parameters such as time required to stop the bleeding and quick pain relief were the most important factors to physicians .…”

Home treatment of haemophilia patients with inhibitors

“…The management of bleeding episodes in haemophilia patients with high‐titre inhibitors [>5 Bethesda units (BU)] [1] is one of the major challenges in haemophilia care today. The prevalence of inhibitors in patients with haemophilia A varies from 20% to 30% [2]. Although less common, people with haemophilia B may also develop inhibitors (estimates show a prevalence of 2–5%) [2].…”

“…The prevalence of inhibitors in patients with haemophilia A varies from 20% to 30% [2]. Although less common, people with haemophilia B may also develop inhibitors (estimates show a prevalence of 2–5%) [2].…”