Cost of hemophilia A in Brazil: a microcosting study.

ACTIVITY-based costing; CAREGIVERS; OLDER patients; HEMOPHILIA; MEDICAL care costs; HEMOPHILIACS

Background: Patients with Hemophilia are continually monitored at treatment centers to avoid and control bleeding episodes. This study estimated the direct and indirect costs per patient with hemophilia A in Brazil and evaluated the cost variability across different age groups. Methods: A prospective observational research was conducted with retrospective data collection of patients assisted at three referral blood centers in Brazil. Time-driven Activity-based Costing method was used to analyze direct costs, while indirect costs were estimated based on interviews with family and caregivers. Cost per patient was analyzed according to age categories, stratified into 3 groups (0–11;12–18 or older than 19 years old). The non-parametric Mann-Whitney test was used to confirm the differences in costs across groups. Results: Data from 140 hemophilia A patients were analyzed; 53 were 0–11 years, 29 were 12–18 years, and the remaining were older than 19 years. The median cost per patient per year was R$450,831 (IQR R$219,842; R$785,149; $174,566), being possible to confirm age as a cost driver: older patients had higher costs than younger's (p = 0.001; median cost: 0–11 yrs R$299,320; 12–18 yrs R$521,936; ≥19 yrs R$718,969). Conclusion: This study is innovative in providing cost information for hemophilia A using a microcosting technique. The variation in costs across patient age groups can sustain more accurate health policies driven to increase access to cutting-edge technologies and reduce the burden of the disease. Highlights: This study provides cost data, measured with microcosting methodology, for Hemophilia A patients in an LMIC, demonstrating how costs are sensible to the patient's age. The results showed the importance of considering patients' clinical and demographic characteristics to establish adequate reimbursement policies driven to reduce the health impact of the disease, due to the cost variability observed. Brazil has one of the biggest hemophilia A populations, and based on the cost measured, the financial burden associated with this condition is estimated to be R$ 5,19 billion yearly. [ABSTRACT FROM AUTHOR]

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