혈우병 환자의 항체 발생에 따른 경제적 부담

Economic Burden of Inhibitor in Patients with Hemophilia

Hemophilia is a bleeding disorder caused by a genetic defect in X-chromosome gene for clotting factors that results in insufficient production of clotting factors. To treat uncontrolled bleeding of patients with hemophilia, clotting factors are injected. Inhibitors against injected clotting factors can develop in 1-30% of patients, which leads to additional clinical and economic burden. However, economic burden of inhibitor in South Korea has not been clearly identified. Using the 2011-2022 National Health Insurance Review and Assessment Service (HIRA) claims data of South Korea, patients with hemophilia were identified. Patients were categorized into inhibitor and non-inhibitor group, and propensity score matching (PSM) was applied to compare per-patient-per-year (PPPY) healthcare costs and utilization. Generalized linear regression model (GLM) was used to identify factors influencing total healthcare costs. Mean PPPY total healthcare cost was significantly higher in the inhibitor group than non-inhibitor group (439.28 million KRW vs. 72.27 million KRW, p<0.001). Among the cost items, injection cost incurred the highest expenditure in both groups with higher cost observed in the inhibitor group (mean PPPY cost, 441.51 million KRW vs. 70.39 million KRW, p<0.001). Additionally, the inhibitor group showed more frequent outpatient visits compared to the non-inhibitor group (mean PPPY, 38.25 visits vs. 23.30 visits, p<0.001). GLM revealed that total healthcare costs were 5.46 times higher in the inhibitor group compared to the non-inhibitor group. The economic burden identified in this study could be useful for decision-making regarding the evaluation and adoption of new drugs for hemophilia, specifically for patients with inhibitors.