PB0533 - Clinical Standard of Care and its Related Costs for Patients with Severe Hemophilia in a Hemophilia Treatment Center in India

Background: India has the second largest population of patients living with hemophilia globally, (n=25,715 registered patients, mostly severe), yet, it ranks the 12th in annual factor consumptions. Although most patients receive treatment free of charge through government schemes, the high cost and difficult access to factor concentrates makes it unfeasible to provide interventions often considered standard of care in high income countries.

Aims: To evaluate and cost out the actual clinical standard of care used to treat patients with severe hemophilia A (HA) and B (HB) in a hemophilia treatment center (HTC) in Noida, Uttar Pradesh, India.

Methods: An online survey was used to collect data from an HTC in India, which caters to approximately 700 hemophilia patients. After review, data were validated using virtual meetings. Clinical approach, unit costs, and dosage regimens were used to calculate the expenditure associated with treating a 21-year-old Indian male patient.

Results: Tables 1 and 2 show the clinical approach and cost of care in Noida HTC. Only 5-10% of patients received prophylaxis with an annual cost of $6,474 for HA and $8,450 for HB. Cost for treating an episode of minor and major bleed using factor concentrate was $249 and $1,204 for HA, and $325 and $1,853 for HB, respectively. In inhibitor patients it was $2,672 and $21,376 using FVIIa, and $3,817 and $26,719 using FEIBA. Immune tolerance induction was not feasible due limited accessibility to factor concentrate.

Conclusion(s): Patients with severe hemophilia in India experience high morbidity, due to poor accessibility to factor concentrate, which in turn affects the feasibility of prophylaxis treatment, joint surgery, and immune tolerance induction. Despite the relative low unit cost of medications in addition to attempts to use lower-dose regimens, the economic burden remained significant. To establish equity for all patients globally, high-standard treatment strategies adapted to available resources are needed.