Introduction: An algorithm for controlling problem bleeds (unresponsive to initial therapy) in patients with severe haemophilia A and inhibitors was suggested in 2007 (Teitel et al. Haemophilia 2007, 13: 256–263). The objectives of this study were to understand how physicians treat problem bleeds (in terms of dose and frequency of administration) and estimate the probabilities of bleed improvement at specific time points. Treatment patterns and estimated probabilities were ultimately used to model the impact of guideline adherence on costs and outcomes. Methods: A panel of seven physicians with experience in the management of inhibitors was recruited and a modified version of the Delphi methodology was utilized to reach consensus on the probabilities of improvement at specific time points and to estimate the amount of bypassing agents that would be used to treat a limb-threatening muscle bleed. The numbers of patients with improved bleeds at 72 h and the average cost of therapy per patient were compared between patients who were treated according to the guidelines and patients who were not. Bypassing agent costs were calculated using 2007 US prices (AWP). Results: The panel answered a total of 37 questions and reached consensus on 73% of them. The probabilities of improvement at specific time points arising as a consequence of guidelines adherence, increased the estimated number of patients improving after 72 h by 17.5% and reduced the number of patients requiring sequential therapy (43.0% vs. 25.5%) as compared to non-adherence. Also regardless of the bypassing agent selected for first-line therapy, the average cost of therapy would decrease by more than $9000 (4.1%) if patients were treated according to the guidelines. Conclusions: This model suggested that guidelines adherence would be expected to not only improve outcomes but also reduce costs, by optimizing the timing of treatment decisions
Modeling costs and outcomes of guidelines adherence in the treatment of problem bleeds in patients with severe haemophilia A and high-titre inhibitors / A. Gringeri, E. Gomperts, C. Leissinger, R. D’Oiron, J. Teitel, G. Young, B. Ewenstein, P.O. Bonnet, E. Berntorp. - In: JOURNAL OF THROMBOSIS AND HAEMOSTASIS. - ISSN 1538-7933. - 7:Suppl. 2(2009 Jul), pp. 829-829. ((Intervento presentato al 22. convegno Congress of the International Society of Thrombosis and Haemostasis tenutosi a Boston, USA nel 2009 [10.1111/j.1538-7836.2009.03473_2.x].
Modeling costs and outcomes of guidelines adherence in the treatment of problem bleeds in patients with severe haemophilia A and high-titre inhibitors
A. GringeriPrimo
;
2009
Abstract
Introduction: An algorithm for controlling problem bleeds (unresponsive to initial therapy) in patients with severe haemophilia A and inhibitors was suggested in 2007 (Teitel et al. Haemophilia 2007, 13: 256–263). The objectives of this study were to understand how physicians treat problem bleeds (in terms of dose and frequency of administration) and estimate the probabilities of bleed improvement at specific time points. Treatment patterns and estimated probabilities were ultimately used to model the impact of guideline adherence on costs and outcomes. Methods: A panel of seven physicians with experience in the management of inhibitors was recruited and a modified version of the Delphi methodology was utilized to reach consensus on the probabilities of improvement at specific time points and to estimate the amount of bypassing agents that would be used to treat a limb-threatening muscle bleed. The numbers of patients with improved bleeds at 72 h and the average cost of therapy per patient were compared between patients who were treated according to the guidelines and patients who were not. Bypassing agent costs were calculated using 2007 US prices (AWP). Results: The panel answered a total of 37 questions and reached consensus on 73% of them. The probabilities of improvement at specific time points arising as a consequence of guidelines adherence, increased the estimated number of patients improving after 72 h by 17.5% and reduced the number of patients requiring sequential therapy (43.0% vs. 25.5%) as compared to non-adherence. Also regardless of the bypassing agent selected for first-line therapy, the average cost of therapy would decrease by more than $9000 (4.1%) if patients were treated according to the guidelines. Conclusions: This model suggested that guidelines adherence would be expected to not only improve outcomes but also reduce costs, by optimizing the timing of treatment decisions
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