The relationship between target joints and direct resource use in severe haemophilia
The relationship between target joints and direct resource use in severe haemophilia
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DOI：
10.1186/s13561-018-0185-7
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发表时间：
2018-01-16
影响因子：
2.4
通讯作者：
Wilkinson, Lars
中科院分区：
文献类型：
--
作者：
O'Hara, Jamie;Walsh, Shaun;Wilkinson, Lars
目的：靶关节是严重血友病的常见并发症。虽然因子替代疗法构成了血友病的大部分成本，但尚未研究靶关节与非药物相关直接成本（NDDC）之间的关系。方法：无抑制物的血友病患者的数据来自“欧洲血友病成本-社会经济学调查”（CHESS）研究，该研究是对5个欧洲国家的重度血友病A和B的成本评估（法国、德国、意大利、西班牙和英国），其中139名血友病专家提供了1285名成人患者的人口统计学和临床信息。NDDC是使用公开的成本数据计算的，包括12个月的门诊和二级护理活动：血液学家和其他专家咨询，医学测试和检查，出血相关的住院，以及向专业护理提供者支付的费用。一个广义线性模型的发展，调查NDDC和目标关节（慢性滑膜炎领域）之间的关系，调整患者covariates.Results：5013例（42%的样本）没有诊断的目标关节;共1376个目标关节（范围1-10）记录在其余的714例。无靶关节患者的平均调整NDDC为3134欧元（标准误（SE）158欧元）;对于有一个或多个目标关节的人，平均调整的NDDC为3913欧元（标准差EUR 157;平均效应平均值EUR 779; p < 0.001）。我们的分析表明，一个或多个靶关节的存在对严重血友病患者的NDDC有显著影响，其他条件相同。靶关节的预防和管理应是管理血友病患者的重要考虑因素。
Objectives: Target joints are a common complication of severe haemophilia. While factor replacement therapy constitutes the majority of costs in haemophilia, the relationship between target joints and non drug-related direct costs (NDDCs) has not been studied.Methods: Data on haemophilia patients without inhibitors was drawn from the 'Cost of Haemophilia across Europe - a Socioeconomic Survey' (CHESS) study, a cost assessment in severe haemophilia A and B across five European countries (France, Germany, Italy, Spain, and the United Kingdom) in which 139 haemophilia specialists provided demographic and clinical information for 1285 adult patients. NDDCs were calculated using publicly available cost data, including 12-month ambulatory and secondary care activity: haematologist and other specialist consultant consultations, medical tests and examinations, bleed-related hospital admissions, and payments to professional care providers. A generalized linear model was developed to investigate the relationship between NDDCs and target joints (areas of chronic synovitis), adjusted for patient covariates.Results: Five hundred and thirteen patients (42% of the sample) had no diagnosed target joints; a total of 1376 target joints (range 1-10) were recorded in the remaining 714 patients. Mean adjusted NDDCs for persons with no target joints were EUR 3134 (standard error (SE) EUR 158); for persons with one or more target joints, mean adjusted NDDCs were EUR 3913 (SE EUR 157; average mean effect EUR 779; p < 0.001).Conclusions: Our analysis suggests that the presence of one or more target joints has a significant impact on NDDCs for patients with severe haemophilia, ceteris paribus. Prevention and management of target joints should be an important consideration of managing haemophilia patients.