The current intervention was made possible with a novel clinical tool (WAPPS-HEMO) that pharmacists can now use that allows individual PK assessments to help the transfusion team optomize coagulation factors. Findings from the current pilot study demonstrated a successful cost-minimization model of adding a trained pharmacist as part of personalized treatment of patients living with hemophilia receiving prophylaxis with coagulation factors. We showed that the substitution of clotting factor products and the reduction of administered doses undertaken by the pharmacist have resulted in savings that were 2.7 times greater than the investment in the pharmacist’s salary, savings that were realized by only the 7th patiet optimization. Indeed, the current intervention demonstrated pharmacists can reduce clotting factor treatment costs by 20.5% (net savings of $12,000 for each treatment optimization).

Slocum et al⁸ had previously demonstrated that the involvement of a pharmacist in the care team for the hemophilia population resulted in significant cost savings. Implementation of their hemophilia management program resulted in an ROI of 20:1. This is higher than ours, but this difference can be explained by the larger number of patients they treat and by the higher pricing of factors in the US. In support of our findings, this study highlighted the fact that the new role given to the pharmacist should not be limited to therapeutic optimization and treatment management alone. The support and counseling of patients and families in treatment management is also important; optimization of treatment on its own is insufficient. This is especially true when dealing with a pediatric population. The pharmacist’s involvement as a member of the care team is crucial to improve practices and deepen the team’s knowledge of medications, thus improving the patient’s clinical outcome and reducing costs.

Due to the one-year time horizon, we were unable to measure long-term outcomes and therefore assumed that patients with and without pharmacist intervention achieved the same outcomes. It is possible that these interventions could lead to improved outcomes such as decreased hospitalizations, in which case more savings would be possible. Although the pharmacist performed therapeutic optimizations for only 9 months, given the initial 3-month phase-in period, savings were calculated on an annual basis to obtain savings over the entire project duration. On a longer time scale, therefore, greater annual savings could be expected. The validity of the costs was difficult to confirm, although this was compensated for by performing a sensitivity analysis. The small population size could be responsible for important cost variations between each of the optimizations made. This limitation challenged whether it is appropriate to extrapolate the results on a larger scale. As the study population was exclusively pediatric, the effect of implementing such a project on adults remains unknown. However, because the doses of clotting factor products consumed in adults are higher, implementation of the project in the adult population could result in significant cost savings. Following the success of this pilot project, it will be continued in children and expanded to adults, bringing more information to a larger number of patients and a broader age group. If the findings in this project continue to be demonstrated, this will be used as a case study to expand to HTCs across Canada.

Our pilot project demonstrated that involvement of a pharmacist in the hemophilia care team allowed for significant reduction in the costs of coagulation factor therapy in Canada. Thorough analyses of PK data, relationships with patients and families, involvement in the care team and development of protocols are activities that can be performed by a pharmacist in a HTC to help improve the management of prophylactic therapy with coagulation factors.