Associated comorbidities, healthcare utilization & mortality in hospitalized patients with haemophilia in the United States: Contemporary nationally representative estimates

• Type of Material: Article
• Authors: Cassandra Josephson, Emory University; Jonathan R Day, University of Iowa; Clifford Takemoto, St. Jude's Children's Research Hospital; Anjali Sharathkumar, University of Iowa; Sarah Makhani, Florida International University; Ashwin Gupta, Vanderbilt University; Stephanie Bitner, SIU School of Medicine, Springfield Illinois; Evan M Bloch, Johns Hopkins University; Aaron AR Tobian, Johns Hopkins University; Lakshmanan Krishnamurti, Emory University; Ruchika Goel, SIU School of Medicine
• Language: English
• Date: 2022-04-12
• Publisher: WILEY
• Publication Version: Final Published Version
• Copyright Statement: © 2022 The Authors. Haemophilia published by John Wiley & Sons Ltd.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1111/hae.14557
• Title of Journal or Parent Work: HAEMOPHILIA
• Volume: 28
• Issue: 4
• Start Page: 532
• End Page: 541
• Keywords: ADULTS; NIS; PROPHYLAXIS; MALES; epidemiology; hospitalization; EXPENDITURES; LIFE EXPECTANCY; DEATH; DISEASE; mortality; United States; haemophilia; Hematology; COSTS; FACTOR-VIII; Science & Technology; Life Sciences & Biomedicine; COMPLICATIONS

Abstract

Introduction: Current in-hospital burden and healthcare utilization patterns for persons with haemophilia (PWH) A and B, including both children (ages < 18 years) and adults (ages ≥ 18 years), in the United States (US) are lacking. Aim: To evaluate healthcare utilization, the prevalence of comorbidities, and mortality in hospitalized paediatric and adult PWH using a contemporary nationally representative cohort. Methods: Hospitalizations of PWH either as the primary reason for admission (principal diagnosis) or one of all listed diagnoses were identified using ICD-10 codes from the 2017 Nationwide Inpatient Sample (NIS), the largest publicly available all-payer inpatient discharge database in the US. Sampling weights were applied to generate nationally representative estimates. Results: The contemporary cohort included 10,555 hospitalizations (paediatrics, 18.3%; adults, 81.7%) among PWH as one-of-all listed diagnoses (n = 1465 as principal diagnosis). Median age (interquartile range) was 46 (24–66) years overall; adults, 54 (35–70) years and paediatric, 4 (1–11). The most common comorbidities in adults were hypertension (33.4%), hyperlipidaemia (23.6%), and diabetes (21.1%). In children, hemarthrosis (11.4%), contusions (9.6%), and central line infections (9.3%) were the most common. The overall mortality rate was 2.3%. Median hospital charges per haemophilia admission were $52,616 ($24,303–$135,814) compared to $26,841 ($12,969–$54,568) for all-cause admissions in NIS. Conclusion: Bleeding and catheter-related infections are the significant reasons for paediatric haemophilia admissions. Adult haemophilia admissions tend to be associated with age-related comorbidities. Costs for haemophilia-related hospitalizations are higher than the national average for all-cause hospitalizations.