Haemophilia. 2021 Nov 10; doi: 10.1111/hae.14448. Epub 2021 Nov 10.
Bleeding patterns in patients before and after diagnosis of von Willebrand disease: Analysis of a US medical claims database.
Haemophilia : the official journal of the World Federation of Hemophilia
Jonathan C Roberts, Lynn M Malec, Imrran Halari, Sarah A Hale, Abiola Oladapo, Robert F Sidonio
Affiliations
Affiliations
- Bleeding & Clotting Disorders Institute, Peoria, Illinois, USA.
- Versiti Blood Center of Wisconsin, Milwaukee, Wisconsin, USA.
- Charles River Associates, Boston, Massachusetts, USA.
- Baxalta US Inc., a, Takeda company, Cambridge, Massachusetts, USA.
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia, USA.
PMID: 34761486
DOI: 10.1111/hae.14448
Abstract
INTRODUCTION: Von Willebrand disease (VWD) is the most common inherited bleeding disorder. The bleeding phenotype is variable, and some individuals have persistent symptoms post-diagnosis.
AIM: To characterize bleeding patterns in patients with VWD before and after diagnosis.
METHODS: De-identified claims data for commercially insured patients in the IQVIA PharMetrics® Plus US database (Jan-2006 to Jun-2015) were extracted. Eligible patients had ≥2 claims for VWD (ICD-9 code 286.4), and continuous health-plan enrolment for ≥2 years before and after diagnosis. Bleeding event, treatment and treating-physician type were analysed for 18 months before and 7-24 months after diagnosis, according to pre-diagnosis bleeding phenotype (claims from one vs multiple bleed sites) and post-diagnosis bleeding status (resolved [no post-diagnosis bleed claims] vs continued [≥1 claim]).
RESULTS: Data for 3756 eligible patients (72.6% female; 71.0% aged ≥18 years at diagnosis) were analysed. Overall, 642 (17.1%) and 805 (21.4%) patients had single- and multiple-site bleed claims pre-diagnosis, respectively, and 1263 (33.6%) patients (38.5% of women, 20.8% of men) continued to bleed post-diagnosis. Multiple-site bleeding was associated with pre-diagnosis heavy menstrual bleeding (HMB), oral contraceptive (OC) use and nasal cauterization. Continued bleeding post-diagnosis was associated with pre-diagnosis gastrointestinal bleeding, HMB and epistaxis; pre-diagnosis use of OCs, aminocaproic acid and nasal cauterization; and younger age at diagnosis. Few patients consulted a haematologist for bleed management.
CONCLUSION: Many patients with VWD have persistent bleeding from multiple sites and continue to bleed post-diagnosis. Our findings suggest a need to optimize management to reduce the symptomatic burden of VWD following diagnosis.
© 2021 The Authors. Haemophilia published by John Wiley & Sons Ltd.
Keywords: database; diagnosis; epistaxis; gastrointestinal haemorrhage; menorrhagia; therapeutics; von Willebrand disease
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