Cost of Severe Haemophilia Across Europe

Resource and cost data were gathered as part of the “Cost of Haemophilia across Europe – a Socioeconomic Survey (CHESS)”, a prospective observational study in severe haemophilia A and B across five European countries (France, Germany, Italy, Spain, and the United Kingdom) undertaken in 2015 [15 (link)]. One hundred and thirty-nine haemophilia specialists provided demographic and clinical information for 1285 adults (≥18 years) via a web-based survey. A corresponding questionnaire covering indirect costs and health-related quality of life (HRQOL) measures was completed by patients.
Non drug-related direct costs (NDDCs) were an amalgam of 12-month ambulatory and secondary care costs gathered within the CHESS study, specifically incorporating: haematologist and other specialist consultant consultations, medical tests and examinations, surgeries relating to joint damage, bleed-related hospital admissions, and payments to professional care providers [15 (link)]. A unit cost database was developed for each country using publicly available information. A breakdown of individual cost elements of NDDCs is presented in Table 1.Table 1

National costs for CHESS resource units

Resource item	Baseline unit price (EUR)
	Francea	Germanyb	Italyc	Spaind	UKe
Ambulatory care
Haematologist visit (per visit)	25.99–45.99	20.88	27.32–23.17	65.69–113.54	124.71–228.57
Nurse visit (per visit)	81.74	34.28–38.42	15.11	20.92–37.46	19.36
Other specialist visit (per visit)	14.99–45.99	7.30–228.88	18.21–27.32	16.42–160	65.91–612.03
Blood test (per test)	1.89–53.96	0.50–112.50	2.11–17.22	4.78–98.37	4.29–7.67
Other test/examination (per test)	10.79–69.00	5.50–124.60	2.19–134.27	7.49–249.21	1.69–228.24
Hospitalisation
Target joint surgery† (per surgery)	28.81–534.40	12.02–1719.43	33.48–1032.91	169.75–2156.33	1161.93–8397.52
Bleed event: ward stay (per day)	290.85	514.29	265	708.71	562.88
Bleed event: ICU stay (per day)	1174.60	1265	366	1559.24	1056.82
Professional caregiver (per hour)	8.30	27.43	7.39	13.66	24.56

Note. Ranges presented where more than one price is possible; ICU: intensive care unit; IU: International Units

†Arthrocentesis, arthrodesis, arthroplasty, arthroscopy, synovectomy

^aSources: Ameli, sante.gouv, ViDAL.fr, Catalogue Commun des actes médicaux

^bSources: Kbv.de, meinpharmaversand.de, Einheitlicher Bewertungsmaßstab, rote-liste service

^cSources: AIFA, agenziafarmaco.gov

^dSources: Oblikue e-salud, Agencia Española de Medicamentos y Productos Sanitarios

^eSources: National Schedule of Reference Costs, Electronic Medicines Compendium

Study exclusion criteria was limited to patients diagnosed with an inhibitor at the time of study capture (n = 52), due to a differing risk profile for bleeds and subsequent target joint development among these patients, and a higher utilisation of medical resources [16 (link), 17 (link)].