International Journal of Technology Assessment in Health Care

General Essays

Cost-effectiveness of prophylaxis against on-demand treatment in boys with severe hemophilia A in Iran

Aliasghar Ahmad Kia Daliria1, Hassan Haghparasta2 and Jahanara Mamikhania3

a1 Ministry of Welfare and Social Security

a2 Karolinska Institute

a3 Behinpuyan Hutan Research Institute


Objective: The aim of this study was to assess the incremental cost-effectiveness of on-demand versus prophylactic hemophilia therapy in Iran from a third-party payers’ perspective.

Methods: A retrospective chart review of twenty-five type A hemophiliacs who were treated in three hemophilia treatment centers was conducted. The patients were boys 0–9 years old receiving one of two treatments: (i) prophylaxis with concentrate at clinic; (ii) concentrate at clinic as on-demand. Fourteen boys received on-demand infusions for bleeding events, and eleven boys received infusions prophylaxis. Data were extracted from documents in the hemophilia treatment centers during a period of approximately 6 months.

Results: The patients receiving prophylactic treatment had fewer bleeding events each month (mean, 0.26 versus 2.74) but used more concentrate (225.31 versus 87.20 units/kg per month). Average monthly cost per patient in the prophylaxis group was approximately 1.9 times higher than in the on-demand group. Compared with on-demand infusion, prophylaxis costs 3,201,656 Rials (€213.45) per bleeding event prevented.

Conclusion: Prophylactic care markedly reduces the number of bleeding episodes, but at considerable cost.


The authors acknowledge that this article is based on a project which was financed by the Health Ministry of Iran, Department of Food and Drug. The authors thank Dr. M. Khatibi, Mrs. Hanieh Sajadi, Mrs. Peivand Bastani, and Mrs. Kimia Pourmohammadi for their help in conducting this study and Miss Laura Bally for her comments. Moreover, the first author thanks the personnel of the hemophilia treatment centers in Tehran, Sfahan, and Shiraz for their cooperation.