{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T08:08:04Z","timestamp":1780560484699,"version":"3.54.1"},"reference-count":28,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T00:00:00Z","timestamp":1780531200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T00:00:00Z","timestamp":1780531200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Haemophilia"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Severe haemophilia A (sHA) is associated with disability, and financial burden. Even with government provided or humanitarian\u2010aid\u2010supported on\u2010demand therapy, households may remain vulnerable to catastrophic health expenditure (CHE).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>To estimate the patient\u2010level costs and economic burden of sHA and to assess CHE under multiple thresholds.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this cross\u2010sectional study, costs were estimated from a patient\/household perspective. Clotting\u2010factor concentrate (CFC) costs were excluded from the base case because factor VIII was provided free through government and\/or humanitarian\u2010aid\u2010supported mechanisms. Costs were standardized to 2025 Indian Rupees using Consumer Price Index (CPI) adjustments (US$ (\u20b990 = US$1)). CHE was assessed at 10% and 25% of total household expenditure and 40% of household capacity to pay.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The median annual patient\u2010level cost per patient, excluding CFCs, was \u20b973,919 (US$821). CHE occurred in 63% of households at the 10% threshold and in 44% at the 40% capacity\u2010to\u2010pay threshold. Distance &gt; 50\u00a0km From the treatment centre (aOR 6.62) and hospitalization history (aOR 10.60) were associated With CHE. Median cost per bleeding episode, excluding factor costs, was \u20b94,468 (US$50; IQR \u20b98,311 [US$92]). HRQoL utilities were modestly reduced and weakly correlated With costs, suggesting a financial\u2013disability utility paradox. Sensitivity analysis identified clotting\u2010factor price as the dominant cost driver<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>SHA imposes substantial financial burden Despite free factor provision. Reliance on on\u2010demand therapy may contribute to recurrent bleeding, hospitalizations, and CHE, whereas long\u2010term replacement strategies may reduce complications and financial toxicity. Prospective comparative studies are needed in resource\u2010constrained settings<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/hae.70323","type":"journal-article","created":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T07:40:28Z","timestamp":1780558828000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Catastrophic Health Expenditure and Health\u2010Related Quality of Life Impairment in Severe Haemophilia A: A Patient\u2010Level Cost\u2010of\u2010Illness Study From India"],"prefix":"10.1111","author":[{"given":"M Joseph","family":"John","sequence":"first","affiliation":[{"name":"Department of Clinical Haematology Haemato\u2010Oncology &amp; Bone Marrow (Stem Cell) Transplantation Christian Medical College  Ludhiana Punjab India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mridul","family":"Makkar","sequence":"additional","affiliation":[{"name":"Department of Clinical Haematology Haemato\u2010Oncology &amp; Bone Marrow (Stem Cell) Transplantation Christian Medical College  Ludhiana Punjab India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Himanshu","family":"Aggarwal","sequence":"additional","affiliation":[{"name":"Department of Clinical Haematology Haemato\u2010Oncology &amp; Bone Marrow (Stem Cell) Transplantation Christian Medical College  Ludhiana Punjab India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Damanpreet","family":"Singh","sequence":"additional","affiliation":[{"name":"Department of Clinical Haematology Haemato\u2010Oncology &amp; Bone Marrow (Stem Cell) Transplantation Christian Medical College  Ludhiana Punjab India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Soumya","family":"Ohja","sequence":"additional","affiliation":[{"name":"Department of Clinical Haematology Haemato\u2010Oncology &amp; Bone Marrow (Stem Cell) Transplantation Christian Medical College  Ludhiana Punjab India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diksha","family":"Sarwan","sequence":"additional","affiliation":[{"name":"Department of Clinical Haematology Haemato\u2010Oncology &amp; Bone Marrow (Stem Cell) Transplantation Christian Medical College  Ludhiana Punjab India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gaurav","family":"Jyani","sequence":"additional","affiliation":[{"name":"Department of Community Medicine &amp; School of Public Health Postgraduate Institute of Medical Education and Research (PGIMER)  Chandigarh India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shankar","family":"Prinja","sequence":"additional","affiliation":[{"name":"Department of Community Medicine &amp; School of Public Health Postgraduate Institute of Medical Education and Research (PGIMER)  Chandigarh India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,4]]},"reference":[{"key":"e_1_2_15_2_1","unstructured":"World Bank Country and Lending Groups\u2013World Bank Data Help Desk[Internet]. 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