Pharmacist Integration into the Hemophilia Treatment Centre: A Canadian
Pilot Project to Optimize Treatment and Improve Cost-savings
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.