High cost, low volume care: the case of haemophilia

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Abstract
Haemophilia is a rare and expensive condition. In Britain it affects 5418 males with factor VII deficiency and 1109 with factor IX deficiency, and in 1994 they used 158 million units of factor VIII and 9 million of factor IX at an average cost of 30p per unit. Over the past 20 years the amount of clotting factor used per patient has increased, and both the quality of the clotting factors and methods of administration have improved. In theory the nature and level of treatment is specified in contracts between purchasers and providers, but at our centre, which cares for 14% of the haemophilic population of England and Wales, contract revenue is regularly outweighed by the cost of care. Our cost pressures are similar to those of any high cost, low volume clinical service in any general trust. Accumulating experience suggests that the present funding arrangements are failing; the danger is that such services will become a liability and be eliminated by both providers and purchasers. Clotting factor concentrate represents 50-80% of the total direct cost of haemophilia care.1 Over the past 15 years the use of concentrate in Britain has risen threefold. …

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