Efficacy of Self-Therapy in Hemophilia

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Abstract
To determine the long-term efficacy of self-therapy in hemophilia, 72 patients with hemophilia were studied. New or progressive hemophilic arthropathy occurred in a total of 90.3 per cent, during a year of traditional emergency-room-based therapy. This figure decreased to 12.5 per cent during the most recent year on the self-therapy program. Patients still at risk were older, were often inadequately insured, and were less vigorous in application of therapy than the study group as a whole. Sixty-seven of 72 hemophilic patients required no hospitalizations during the study year, excluding elective surgery. Costs of therapy declined by 40 per cent. The patient-education aspect of the program led to two cases of possibly lifesaving early recognition and therapy of severe emergency, and to two cases of morbidity due to errors in patient judgment. The risk-benefit ratio for properly supervised self-therapy clearly favors this mode of health-care delivery. (N Engl J Med 291:1381–1384, 1974)

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