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Examining the Hemophilia Disability Paradox

1CHOC Children's Hospital, Department of Pediatrics and Division of Hematology, Orange, United States, 2HCD Economics & University of Chester, Daresbury, United Kingdom, 3HCD Economics, Daresbury, United Kingdom, 4Hemophilia and Thrombosis Center, University of Colorado School of Medicine, Aurora, CO, United States, 5Institute for Policy Advancement, Ltd., Washington, DC, United States, 6McMaster University, Hamilton, ON, Canada, 7Irish Haemophilia Society, Dublin, Ireland, 8Trinity College Dublin, Dublin, United Kingdom, 9University of Technology Sydney, Sydney, Australia, 10uniQure, Inc., Boston, MA, United States

Abstract Number: PB0817

Meeting: ISTH 2020 Congress

Theme: Hemophilia and Rare Bleeding Disorders » Hemophilia - Basic

Background: In economic evaluations, health-state-utility-valuations (HSUV) for quality-of-life (QoL) estimates inform the cost-effectiveness of new interventions. HSUVs are estimated by eliciting the preferences of people for different health-states. However, people with inherited and long-term health conditions, such as hemophilia, may adapt to their given health-state. This “disability paradox” could mean that QoL estimates for the same health-state derived from people with hemophilia (PWH) may be valued higher compared to the general population (GP).

Aims: This study aimed to explore differences in preferences for the same health-states elicited from PWH and GP and whether there were differences in the preferences elicited across hemophilia severity.

Methods: A discrete choice experiment (DCETTO) was completed by 283 PWH and 1,900 GP to derive HSUVs between July-to-September 2019 in the USA. Participants indicated their preferences for hypothetical EQ-5D-5L health-states with a duration attribute. A total of 120 DCETTO choice tasks were administered online, with participants completing 15. Dominated and repeated scenarios were included to test for inconsistencies in responses. Conditional-logit regressions were used with random sampling of GP to match PWH for a balanced comparison. Model estimates were compared and QoL-weights developed to adjust for differences in preferences.

Results: Responses were collected from 1,327 people (1,150 GP, 177 PWH including 104 Severe, 40 Moderate, 33 Mild) after removal of respondents failing consistency-checks. Sampling for age and gender (male-only), mean HSUV difference between PWH and GP was 0.17. By disease severity, mean HSUV differences between severe PWH and moderate PWH with GP were 0.13 and 0.17, respectively. Limited sample size precluded analysis for mild PWH.

Conclusions: These findings demonstrate the presence of disability paradox in hemophilia. QoL estimates for the same health-states derived from PWH may be valued higher compared to GP, indicating under-estimation of the impact of hemophilia.

Disclaimer: HCD Economics were funded by uniQure to undertake this research.

To cite this abstract in AMA style:

Nugent D, O'Hara J, Martin A, Morgan G, Buckner T, Skinner M, O'Mahony B, Mulhern B, Sawyer EK, Li N. Examining the Hemophilia Disability Paradox [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/examining-the-hemophilia-disability-paradox/. Accessed September 22, 2023.

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