Case Study #1

Use of an HTC versus a traditional site of care

A patient with mild Hemophilia A and a high-titer inhibitor (more inhibitor present in the blood) was being treated outside of an HTC and was receiving two clotting factors from a specialty pharmacy. The second clotting factor was necessary to treat the inhibitor. The patient requested to receive care and the clotting factors from a HTC pharmacy.

• The original specialty pharmacy dispensed factor between 5% to 10% above target.
• HTC’s assay management intervention resulted in dispensing at 1% to 4% below target; HTC dispensed each factor medication at $0.26 and $0.60 lower per unit than the specialty pharmacy.

Outcomes:

• The HTC’s per-unit price differences resulted in $287,000 per month in cost savings for the employer.
• An additional $460,000 in savings for the employer was achieved through the HTC’s precise management of clotting factor fills and medical management of the inhibitor.

Case Study #2

Use of an HTC and choice of therapy to treat an inhibitor

A patient covered by a self-funded employer was receiving clotting factor through a specialty pharmacy. After the patient developed an inhibitor his physician decided to switch the patient to a substitution therapy. At the same time, the patient’s care was transferred to the local Hemophilia Treatment Center (HTC) to more carefully manage the complications associated with the inhibitor.

Outcomes:

• The typical cost (wholesale acquisition cost) of bypassing agents is over $1 million per year based on the average weight of a person with hemophilia A with an inhibitor.
• The choice of substitution therapy and the HTC pharmacy saved the employer $500,000 in one year based on drug costs.
• Additional savings could be realized through other ancillary services delivered as components of the HTC comprehensive care model.

Case Study #3

Choice of prophylaxis therapy and use of an HTC

A man with Hemophilia A was injecting clotting factor twice a week. The specialty pharmacy cost was nearly $70,000 per month. The man switched to substitution therapy and started using an HTC pharmacy.

Outcomes:

• By moving to the different therapy and the HTC pharmacy, the employer saved $350,000 in one year based on drug costs:
  • $235,000 from the switch to substitution therapy
  • $115,000 from using the HTC pharmacy

Case Study #4

Indiana Hemophilia Surveillance Project: People with hemophilia in Indiana and use of HTCs

This project identified all people with hemophilia who resided in Indiana from 2011 to 2013 to determine the percentage of patients cared for at an HTC. A retrospective review of medical charts was conducted using methods involving a variety of medical care resources including hospitals, administrative claims data and hematology/oncology clinic reports.

Outcomes: Results showed a higher incidence and prevalence of hemophilia in Indiana during the review period compared to national estimates from the same period. Of the 704 hemophilia cases/patients who resided in Indiana:

• 81.7% were seen at one of the seven different HTCs included in the study.
• Patients from these HTCs were more likely to have severe hemophilia.
• Frequency of emergency room visits among these HTC patients was 47.1% lower than patients who did not use the HTCs (17.6% of HTC patients utilized the emergency room compared to 33.3% of non-HTC patients).
• Prophylaxis adherence for severe hemophilia patients seen at an HTC was 30% higher compared to severe hemophilia patients seen at a non-HTC.