Healthcare utilization and expenditures of parents with and without hemophilia A children

Abstract

Background: There is a growing body of evidence characterizing the experience of caring for children with hemophilia A (HA), which includes negative impact on health-related quality of life, emotional stress, and financial burden. Caregiving in general has been shown to also impact physical health and work productivity. How these effects translate to caregivers’ utilization of non-mental and mental health services is unknown, and its elicitation can inform future evaluations of interventions that address caregiver burden in this space. Objective: To understand the impact of caring for HA children on parents’ utilization of non-mental health and mental health services by comparing one-year costs and number of medical and pharmacy claims with parents of non-HA children. Methods: Retrospective matched cohort study using MarketScan® commercial inpatient, outpatient, and drug claims from 2011-2019. HA children were male, age <18, child or dependent policy holders, had ≥1 HA-related medical claim from 2011-2018 (one was randomly chosen to set the index date), and either a HA-related procedure or drug claim. Parents of HA children (HAP) were adults who were primary and secondary policy holders, shared the same family ID as HA children, continuously enrolled for one year post-index, and for whom comorbidity scores for one year pre-index could be determined. HAP were matched (1:2) with parents of non-HA children on age, sex, beneficiary type, child’s age, number of children, index month and year, health plan type, employment status, and region. Primary outcomes were mean non-mental and mental healthcare costs in 2020 US dollars, and secondary outcomes were 1) mean number of non-mental health outpatient claims, 2) utilization of mental health outpatient or drug claim, and 3) all outcomes excluding parents with HA themselves. Outcomes were compared using two-sided, paired t-tests and McNemar’s test. Results: Of 305.8 million enrollees from 2011-2018, 2,246 HAP were identified of which 1,068 met inclusion criteria and were matched to 2,122 control parents. Mean one-year costs for HAP were moderately higher but not statistically significant for both non-mental health services (mean difference of $1,826; 95% CI: -1,000, 4,652; p=0.20) and mental health services (mean difference of $14; 95% CI: -77, 105; p=0.76). Mental health services costs were significantly higher for HAP when parents with HA themselves were excluded, yielding a mean difference of $676 (95% CI: 399, 953; p<0.001). HAP also had more non-mental health outpatient claims with a mean difference of 1.9 (95% CI: -1.1, 4.9; p=0.21) and were 1.2 times (95% CI: 0.99, 1.45; p=0.07) more likely to have a mental health outpatient or drug claim. Conclusion: HAP had moderately higher healthcare costs and utilization compared to parents of non-HA children; however, these results were not statistically significant. Future studies to better characterize HA disease severity in claims data and assess its impact on caregiver burden or expand caregivers to spouses of adult HA patients may be warranted. Limitations include inability to ascertain severity of HA in children and the use of claims data to capture potentially complex effects on healthcare utilization.