Risorse utilizzate dal servizio sanitario nazionale e relativi costi per la gestione dell’emofilia A

[Autom. eng. transl.] The management of haemophilic patients has improved over the years thanks to the introduction of effective and increasingly safe treatments. This aspect is associated with a high consumption of resources, both economic and human, given the complexity of the pathology, especially when hemophiliacs develop inhibitory antibodies or joint complications. The analysis shows that factor VIII infusion is the main cost driver (97-98% of the total), followed by the expense associated with hospitalizations, other costs and diagnostics, as confirmed by the available literature. According to what emerged from the comparison of the estimate of the costs of the different therapeutic alternatives, it is found that the drugs containing recombinant factors have higher annual costs compared to the plasma derivatives. Haemophilic patients, risking serious bleeding, also following interventions that in themselves would be simple to perform and free of complications, and having chronic arthro-muscular problems due to repeated articular and muscular haemorrhages, must often resort to hospitalization. The costs for hospitalization are approximately € 12 million per year, with a minimum percentage attributable to the operations of prostheses (DRG 209). Average annual costs per patient for haemophilia A in Italy range between € 150,133.19 and € 248,413.19 based on the type of drug treatment (plasma-derived, second and third generation) to which the adult patient is subjected. It was also considered the subgroup of patients who develop inhibitors, as their management involves special treatments and precautions, especially in the case of drug treatment. The average annual cost per patient with inhibitors was estimated at € 217,987.7, of which 98.3% was attributable to drug treatment. It should be emphasized that this data is underestimated as the considerable cost involved in implementing the therapeutic regime of induction of immunotolerance (ITI) aimed at eradicating the circulating inhibitor must also be considered. However, in view of the huge management costs associated with the adoption of ITI schemes, more and more interest is now being focused on identifying therapeutic strategies and commercial policies that can, in some way, limit the economic impact. Baxter, in this context, has recently proposed an innovative model of public-private partnership for the benefit of the patient for easier access to the ITI therapeutic approach. Finally, it should be considered that the increase in the life expectancy of the haemophilic subjects will lead to a consequent increase in the costs of managing this pathology, aggravated by the typical diseases of aging.