Page 6 - Roche Hemlibra Non-inhibitors - Product Monograph
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Repeated intra articular bleeds into the same joints:











                                                         Swelling


                          Significant                                                  Limited
                           joint pain                                             range of motion



           Hemophilic arthropathy may ultimately require surgical intervention, including joint replacement at
           young age (Riley et al. 2011). Increased functional disability due to hemophilia symptoms is a major
           burden for patients, affecting daily life activities (Tlacuilo Parra et al. 2010; Witkop et al. 2015). Costs
           of care are especially high with joint bleeds and hemophilic arthropathy.


           HEALTH-RELATED QOL
           The symptom and treatment burden associated with hemophilia A can have a major impact
           on HRQoL of hemophilic patients through the following:

           • Pain has been shown to have a considerable impact on patient's HRQoL and interferes with
             patient’s activities (Forsyth et al. 2015).

           • Worse physical HRQoL has been reported for patients with hemophilia A compared with the
             general population (Poon et al. 2012; Pollmann et al. 2013; St Louis et al. 2016), with physical
             HRQoL decreasing significantly with increasing severity of the disease (Poon et al. 2012; Pollmann
             et al. 2013).

           • Repeated intra articular bleeding in the same joints (target joints) is a major contributor to
             decreased HRQoL in patients with hemophilia A, because the joint damage associated with
             multiple hemarthroses may progress to hemophilic arthropathy (Klamroth et al. 2011; Riley et al.
             2011; Gringeri et al. 2013).

           While physical limitations are a key cause of diminished HRQoL, the psychological impact,
           coping strategies, and emotional reactions to a life restricting disease vary with life stage and by
           person, and are important consequences beyond the physical problems the condition can

           cause (Cassis 2007).


           3.2. CAREGIVER BURDEN
           Having a family member with hemophilia inevitably increases the burden on the caregivers and
           the family (Khair and von Mackenson 2017).


           Hemophilia has intangible costs, including reduced QoL, pain and suffering of the individual
           and family, and emotional and physical toll on the patient and caregivers.




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