School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
Haemophilia. 2021 Mar;27(2):e187-e193. doi: 10.1111/hae.14250. Epub 2021 Feb 6.
Taiwan's National Health Insurance Program approved reimbursement of prophylactic coagulation factor replacement therapy (CFRT) for patients with haemophilia (PWH) in 2014.
To examine 15-year trends and the impact of reimbursement for prophylactic CFRT on its utilization and related medical costs for PWH.
We analysed Taiwan's National Health Insurance Database from 2003 to 2017. We included patients with haemophilia A (PWHA) or B (PWHB) receiving coagulating factor. Female patients were excluded because of small sample size. We analysed annual consumption of CFRT units and medical costs. High proportion of days covered (PDC) with CFRT served as an indicator for prophylactic treatment since it reflects routine use of CFRT. We applied interrupted time series analysis (ITSA) to evaluate the impact of reimbursement for prophylactic CFRT on usage patterns and medical costs.
We included 896 male PWHA and 181 male PWHB, with 38.1% and 37.0% aged under 18 years, respectively. By ITSA, we found the trends in coagulation factor consumption and PDC significantly increased after reimbursement for prophylactic CFRT in both PWHA and PWHB (p values for trend change <0.05). The overall medical costs per patient increased with increasing consumption of coagulation factor; however, ITSA revealed non-CFRT cost decreased after reimbursement of prophylactic CFRT for both PWHA and PWHB (p values <.05).
Reimbursement for prophylactic CFRT facilitated growth in rates of prophylactic CFRT and increased related costs, but curbed rising non-CFRT costs. These findings provide strong grounds for future cost-effectiveness studies to leverage prophylactic CFRT for its therapeutic benefits.
2014 年，台湾全民健康保险计划批准为血友病患者（PWH）报销预防性凝血因子替代疗法（CFRT）。
研究预防性 CFRT 报销 15 年来的趋势及其对 PWH 预防性 CFRT 的利用和相关医疗费用的影响。
我们分析了 2003 年至 2017 年台湾全民健康保险数据库。我们纳入了接受凝血因子治疗的甲型血友病（PWHA）或乙型血友病（PWHB）患者。由于样本量小，排除了女性患者。我们分析了 CFRT 单位的年消耗量和医疗费用。CFRT 的高比例覆盖天数（PDC）作为预防性治疗的指标，因为它反映了 CFRT 的常规使用。我们应用中断时间序列分析（ITSA）来评估预防性 CFRT 报销对使用模式和医疗费用的影响。
我们纳入了 896 名男性 PWHA 和 181 名男性 PWHB，分别有 38.1%和 37.0%的年龄在 18 岁以下。通过 ITSA，我们发现 PWHA 和 PWHB 预防性 CFRT 报销后，凝血因子消耗和 PDC 的趋势明显增加（趋势变化的 p 值均<0.05）。每位患者的总体医疗费用随凝血因子消耗的增加而增加；然而，ITSA 显示 PWHA 和 PWHB 预防性 CFRT 报销后非 CFRT 成本降低（p 值均<.05）。
预防性 CFRT 报销促进了预防性 CFRT 使用率的增长，并增加了相关费用，但遏制了非 CFRT 成本的上升。这些发现为未来的成本效益研究提供了强有力的依据，以利用预防性 CFRT 发挥其治疗效益。
