Abstract
Coagulation factors used in
prophylactic treatment of patients with clotting disorders are
associated with significant costs to health care systems. These products
have complex pharmacokinetic profiles subject to large inter-individual
variation making their efficient use challenging. Prior to this project,
pharmacists were not involved as part of the Hemophilia care teams
across Canada. The purpose of this
pilot project was to determine whether employment of a pharmacist with
expertise and a focus on plasma protein and related products including
hemophilia treatments, would be an effective strategy to reduce costs
associated with clotting factor prophylaxis regimens and identify the
pharmacist’s activities associated with this new role. A
cost-minimization analysis was conducted to compare the addition of a
pharmacist to the care team of the Hemophilia Treatment Centre (HTC) at
a pediatric hospital serving 500,000 children and youth. The analysis
was performed from the perspective of the formulary manager, Canadian
Blood Services, over a 1-year period including 9 months of
interventions. The pharmacist performed 18 therapeutic optimizations on
14 patients with moderate to severe hemophilia A or B, and 1 von
Willebrand patient, aged 3 to 18 years old. As a result of the
pharmacist’s intervention, clotting factor treatment costs extrapolated
over one year were reduced by 20.5% for these patients. This represents
a net savings of $225K CAD/year, or $12.5K CAD/optimization/year. The
addition of a pharmacist to the HTC to manage recombinant and
plasma-derived coagulation factors can optimise the treatment plan and
significantly reduce the costs of managing patients with hemophilia.