Total Knee Arthroplasty among Medicare Beneficiaries with Hemophilia A and B Is Associated with Increased Complications and Higher Costs

Rosas, Samuel; Buller, Leonard T.; Plate, Johannes F.; Barsoum, Wael K.; Emory, Cynthia L.

doi:10.1055/s-0039-1696691

Cited by 11 publications

(4 citation statements)

References 38 publications

(45 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Both joint and nonjoint bleeds were assumed to be treated on-demand, with two doses of FVIII at the aforementioned cost of standard prophylaxis for a dose of 50 IU/kg of standard FVIII per bleed event 25 . Individuals in either treatment arm who underwent surgery incurred a cost of $40,560 for joint replacement surgery 40,41 .…”

Section: Treatment Bleed Management and Surgery Costsmentioning

confidence: 99%

Assessing the potential cost-effectiveness of a gene therapy for the treatment of hemophilia A

Cook

Forbes

Adamski

et al. 2020

Journal of Medical Economics

View full text Add to dashboard Cite

Aim: Hemophilia A is a genetic, chronic disorder classified by deficient or defective coagulation factor VIII (FVIII) that puts those affected at risk for spontaneous bleeding episodes, which lead to joint damage and chronic pain over time. Currently, most severe hemophilia A patients are treated with prophylactic FVIII, which requires costly and frequent infusions and lifelong adherence to medication. A gene therapy (valoctocogene roxaparvovec) is currently in development for the treatment of severe hemophilia A. This model assessed the potential cost-effectiveness of treating patients with valoctocogene roxaparvovec rather than prophylactic therapy. Materials and methods: We developed an individual-based, state-transition microsimulation model for assessing the likely cost-effectiveness of valoctocogene roxaparvovec compared to prophylactic FVIII. Men aged 30 with severe hemophilia A were modeled over a lifetime horizon, and costs were reported from the perspective of the United States health care system. Through microsimulation, patient-level heterogeneity was captured in starting weight, starting Pettersson score (PS), durability of valoctocogene roxaparvovec, and annual bleed rate (ABR). Results: The model projects that treatment with single-administration valoctocogene roxaparvovec would be cost-saving to people with hemophilia A at a price point comparable to other currently available gene therapy products due to its potential to reduce FVIII utilization, direct medical costs, lifetime bleeds, and accumulated joint damage. Limitations: The model relies upon evidence-based assumptions for clinical inputs due to limited data availability. Such uncertainty was mitigated by modeling heterogeneity across the population, specifically with regards to long-term gene therapy durability, lifetime bleed rates, and joint damage progression. Conclusion: Valoctocogene roxaparvovec was found to be cost-saving-on average by about $6.8 million per patient-and more effective than prophylactic therapy for treatment of hemophilia A. The comparative benefit of gene therapy was observed across a broad range of simulated patients that were representative of the real-world severe hemophilia A population.

show abstract

Section: Treatment Bleed Management and Surgery Costsmentioning

confidence: 99%

Assessing the potential cost-effectiveness of a gene therapy for the treatment of hemophilia A

Cook

Forbes

Adamski

et al. 2020

Journal of Medical Economics

View full text Add to dashboard Cite

show abstract

“…PWH showed higher odds of PJI (1.78 versus 0.98%). Reimbursements of 90 days were higher for subjects with hemophilia (mean: $22,249 versus $13,017) [ 43 ].…”

Section: Resultsmentioning

confidence: 99%

Complications and Implant Survival of Total Knee Arthroplasty in People with Hemophilia

Rodríguez-Merchán

Corte‐Rodríguez²,

Álvarez-Roman³

et al. 2022

JCM

View full text Add to dashboard Cite

Total knee arthroplasty (TKA) is a commonly used option in advanced stages of knee arthropathy in people with hemophilia (PWH). The objective of this article is to determine what the complication rates and implant survival rates in PWH are in the literature. A literature search was carried out in PubMed (MEDLINE), Cochrane Library, Web of Science, Embase and Google Scholar utilizing the keywords “hemophilia TKA complications” on 20 October 2022. It was found that the rate of complications after TKA in PWH is high (range 7% to 30%), although it has improved during the last two decades, possibly due to better perioperative hematologic treatment. However, prosthetic survival at 10 years has not changed substantially, being in the last 30 years approximately 80% to 90% taking as endpoint the revision for any reason. Survival at 20 years taking as endpoint the revision for any reason is 60%. It is possible that with a precise perioperative control of hemostasis in PWH, the percentage of complications after TKA can be diminished.

show abstract

“…The outcomes assessed in this study included postoperative complications and costs. Diagnosis codes used to identify and compare complications in the postoperative period were similar to those used in previous studies and are reported in [ 13 ]. Reimbursement data for day-of-surgery and the ninety-day postoperative period were collected as a surrogate for costs[ 14 ].…”

Section: Methodsmentioning

confidence: 99%

Dermatomyositis and polymyositis in total hip arthroplasty

Rosas¹,

Schallmo²,

Gowd³

et al. 2021

WJO

Self Cite

View full text Add to dashboard Cite

BACKGROUND Idiopathic inflammatory myopathies (IIM) are systemic autoimmune disorders such as dermatomyositis (DM), polymyositis (PM), inclusion body myopathy, and autoimmune necrotizing myopathy that, similar to osteoarthritis, affect quality of life and activities of daily living. Moreover, these patients are often burdened with chronic pain and disability; however, the outcomes and risk of total hip arthroplasty (THA) in this patient population remain unclear. AIM To evaluate 90-d complications and costs in patients with these conditions. METHODS A retrospective case control study was designed by accessing data from the Medicare dataset available on the PearlDiver server. Patients with IIM, here, those with DM and PM were matched based on possible confounding variables to a cohort without these diseases and with the same 10-year risk of mortality as defined by the Charlson Comorbidity Index Score (CCI). Univariate and multivariate analysis were performed to evaluate complications and t-tests to evaluate 90-d Medicare reimbursements as markers of costs after THA. RESULTS The total sample was 1090 patients with each cohort comprised of 545. Females were 74.9% of the population. The mean CCI was 5.89 (SD 2.11). Those with IIM had increased rates of pneumonia [odds ratio (OR) 1.45, P < 0.001] and pulmonary embolism (OR 1.46, P = 0.035) and decreased hematoma risks (OR 0.58, P = 0.00). 90-d costs were on average $1411 greater for those with IIM yet not significantly different ( P = 0.034). CONCLUSION Patients with IIM have an increased 90-d rate of pneumonia and pulmonary embolism concomitant with a decreased hematoma rate consistent with their pro-coagulatory state. Further attention to increased resource utilization in these patients is also warranted.

show abstract

Total Knee Arthroplasty among Medicare Beneficiaries with Hemophilia A and B Is Associated with Increased Complications and Higher Costs

Cited by 11 publications

References 38 publications

Assessing the potential cost-effectiveness of a gene therapy for the treatment of hemophilia A

Assessing the potential cost-effectiveness of a gene therapy for the treatment of hemophilia A

Complications and Implant Survival of Total Knee Arthroplasty in People with Hemophilia

Dermatomyositis and polymyositis in total hip arthroplasty

Contact Info

Product

Resources

About