J Korean Med Sci.  2023 Jul;38(30):e235. 10.3346/jkms.2023.38.e235.

Complication Analysis in Korean Patients With Hemophilia A From 2007 to 2019: A Nationwide Study by the Health Insurance Review and Assessment Service Database

• Choi YB
• Shim YJ
• Kim SG
• Lee WK
• on behalf of the Benign Hematology Committee of the Korean Pediatric HematologyOncology Group (KPHOG)

• KMID: 2544953
• DOI: http://doi.org/10.3346/jkms.2023.38.e235

Abstract

Background
There has been remarkable progress in hemophilia A (HA) treatment in Korea. Viral inactivation products were developed in 1989, use of recombinant factor VIII (FVIII) concentrates started in 2002, and prophylaxis expanded thereafter. This study was conducted to identify the changes in complications in HA before and after 1989 or 2002.
Methods
The study was performed using the 2007–2019 Healthcare Big Data Hub of the Health Insurance Review and Assessment Service.
Results
Among 2,557 patients, 1,084 had ≥ 1 complication; 829 had joint problems, 328 had viral infections, 146 had neurologic sequelae, and 87 underwent 113 surgeries or procedures due to complications. Patients born after 1989 had a significantly lower risk of viral infections than those born before 1989; 27.1% vs. 1.4% (P < 0.001, odds ratio [OR], 0.037). Patients born after 2002 had a significantly lower risk of joint problems than those born before 2002; 36.8% vs. 24.7% (P < 0.001, OR, 0.538). Patients born after 2002 had a higher incidence of neurologic sequelae than those born before 2002; 3.7% vs. 11.1% (P < 0.001, OR, 3.210). Medical expenses for complication-associated surgeries or procedures were ₩2,957,557,005.
Conclusion
Viral infections have significantly decreased in Korean patients with HA. The degree of reduction of joint problems was lower than we expected, because it took > 10 years to expand prophylaxis widely. Neurologic sequelae have not decreased; thus, additional efforts to decrease intracranial hemorrhage are needed. We suggest personalized dosing of FVIII and more meticulous care during childbirth to further reduce the complications.

Keyword

Epidemiology; Hemarthrosis; Hemophilia A; Intracranial Hemorrhage; Viral Diseases

Figure

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  Fig. 1 History of the development of management for Korean hemophilia A.FVIII = factor VIII, rFVIIIc = recombinant factor VIII concentrate.

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  Fig. 2 Process of identification and sorting of Korean patients with HA from the 2007–2019 Korean HIRA database.HA = hemophilia A, HIRA = Health Insurance Review and Assessment Service.

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