Financing the rising cost of haemophilia care at a large comprehensive care centre.

Haemophilia affects 1 in every 6,000 males. Patients with haemophilia A receive treatment with factor VIII (FVIII) and those with haemophilia B receive factor IX (FIX). In the UK, patients receive their treatment from comprehensive care centres (CCCs) or haemophilia centres. Over the last two decades the amount of clotting factor used per patient has increased; the quality of the clotting factors available and the methods of administration have also improved. As a consequence, the cost of providing care has increased substantially. In theory, the nature and level of haemophilia treatment is specified in contracts between purchasers and providers, ensuring that the costs of treating patients are fully recovered. However, at our large CCC, which has 1,700 registered patients with inherited bleeding disorders, the costs of care regularly exceed contract revenue. This paper describes the cost pressures and difficulties faced by a North London Trust in an attempt to maintain, and in some instances improve, the services provided within its CCC.