Hemophilia: A High Cost Low Volume Disease: Suitable Preventive Strategies for Developing and Developed Countries

摘要

Hemophilia A & B are congenital bleeding disorders affecting 1:10-20,000 population and 1:20 to 40,000population respectively. Hemophilia represents the prototype of high cost low volume disease. Eighty persons of worldhemophilia population lives in financially poor developing countries, where <2% of GDP is usually spent for total healthcare. In India, with a population of more than 1 billion and growth rate of around 2% atleast 2000 new hemophilia patientsare born every year . On a conservative estimate 50% of them have severe disease and with modern treatment, will requireadditional USD 36,000/year/patient i.e a 36 million dollar incremental additional health care burden each year to managethese 1000 severe hemophilia patient. Which is added to our existing pool of haemophiliacs, estimated at 1,00,000-1,20,000.One of the ways to manage this challenge is to establish prenatal diagnostic centres, for hemophilia, spread widely foreasy accessibility. These diagnostic centers can eventually develop into prenatal diagnosis centres for other diseases likecommon hemoglobinopathies and they should be equipped with modest molecular diagnostic facilities.Presently there are a series of techniques of different levels of difficulties and complexities, available for foetal tissuesampling and laboratory detection of prenatal diagnosis of hemophilia, allowing a centre to chose the technology suitablefor their expertise and financial capability.