Pharmacoeconomics of Orthopedic Surgery in Hemophilia

Healthcare systems need to address growing demands with increasingly limited resources. To accomplish this goal, economic evaluations of health interventions must be performed. Their implementation, however, can be complex because they must quantify all factors involved in a particular surgical procedure. It is also important to detect overspendings. An important amount of Spanish economic resources is spent in drugs used in different diseases. This fact, together with the absence of a Spanish state agency performing economic evaluations, highlights the paramount role of Pharmacy Departments in Spanish medical centers. Pharmacy Departments look for pharmacological efficiency (greater therapeutic benefit at a lower cost) by means of pharmacoeconomic studies. Comparative studies of different therapeutic options, both in terms of costs and benefits, are particularly relevant. A number of factors can influence the high cost of orthopedic surgery in hemophilia. The most important are the severity of the disease, the patient’s weight, the type of surgery, and the origin of factor concentrates used. The estimated cost of the perioperative treatment of an arthroscopic debridement (knee, ankle) ranges between 20,000 and 30,000 €, while the cost of a total knee replacement (TKR) or a total hip replacement (THR) ranges between 40,000 and € 50,000. Factor concentrates used in the management of persons with hemophilia cause a great economic impact in the Spanish universal public health system. To ensure its survival, costs must be minimized.