What changes when bleeding events become more frequent? In this European cohort, both health-related quality of life and work productivity declined as annual bleeding events increased. Haemophilia A is associated with a substantial healthcare burden, with the greatest burden carried by individuals with severe disease.

In 2014, estimated total annual per-patient expenditures across five European countries averaged two hundred thousand euros, with ninety-eight percent of the economic burden driven by drug expenditures. Real-world evidence is crucial for quantifying the substantial burden of disease and informing the future treatment of haemophilia A.

The analysis explored the impact of bleeding events on health-related quality of life and work productivity in Europe using a subset of adults with haemophilia A without inhibitors from the CHESS II retrospective study. Participants were treated with either replacement factor products or a monoclonal antibody and were not participating in a clinical trial at recruitment.

The analysis focused on males aged eighteen to sixty-four years with haemophilia A without inhibitors who were receiving replacement factor products or a monoclonal antibody. The outcomes were analysed using EuroQol’s EQ-5D-5L index, the EQ-VAS analogue scale, and WPAI:SHP percentage scores, stratified by zero, one, two, three to four, or at least five annual bleeding events.

Eligible physicians retrospectively enrolled, on average, seven to eight patients with haemophilia for a twelve-month period before the clinical consultation, or index date. Physicians completed an electronic case report form for the patients they had most recently consulted with.

Bleeding events in the last twelve months were recorded. Health-related quality of life was evaluated using the EQ-5D-5L questionnaire and EQ-VAS. The EQ-5D-5L comprises five domains: mobility, self-care, usual activities, pain or discomfort, and anxiety or depression.

For the EQ-5D-5L index, a score of one equates to perfect health, while decreasing numbers indicate incrementally worse health using a UK value set and weights. The EQ-VAS recorded each patient’s self-rated health from one hundred, the best health imaginable, to zero, the worst health imaginable.

Table one describes the three hundred and eighteen patients with haemophilia A, grouped by annual bleeding events, or ABs: from zero through one, two, three or four, and at least five. It reports age, race and ethnicity, country, and employment status; mean age ranges from thirty point zero years in the zero-AB group to thirty-six point six in the three-or-four group.

The table provides the baseline context for interpreting later analyses of health and work-related outcomes across bleeding-event categories. Of nine hundred eighteen males with haemophilia A in CHESS II, three hundred eighteen met the inclusion criteria and had health-related quality-of-life data available; the mean age was thirty-three point eight years, and ninety-six percent were White.

The mean number of annual bleeding events over the preceding twelve months was two point seven, with twenty percent reporting three or four events and seventeen percent reporting at least five. Mean EQ-5D-5L index scores were zero point nine two for zero events, zero point seven six for one or two, zero point seven one for three to four, and zero point five six for at least five events.

Figure one links annual bleeding events with health-related quality of life in haemophilia A. The mean EQ-5D-5L index score is zero point nine two for patients with no annual bleeds and zero point five six for those with at least five, while mean self-rated EQ-VAS scores are eighty-six point nine and sixty-one point two, respectively.

Across mobility, self-care, usual activities, pain or discomfort, and anxiety or depression, the chart also reports the proportion with no or slight problems, showing the burden across specific health dimensions. Mean EQ-5D-5L index scores declined as bleeding events increased: zero point nine two for zero events, zero point seven six for one or two, zero point seven one for three to four, and zero point five six for at least five.

The percentage of patients in the top two EQ-5D-5L domain levels also reflected reduced health-related quality of life with increasing annual bleeding events. For mobility, ninety-six percent of patients with no events reported no or slight problems, compared with seventy-two percent of those with three or four and sixty-five percent of those with at least five.

Among patients with no events versus at least five, no or slight problems were reported for self-care by ninety-four versus seventy-four percent, usual activities by ninety-six versus sixty-seven percent, pain or discomfort by ninety-four versus fifty-two percent, and anxiety or depression by ninety-two versus seventy-eight percent.

Figure two shows mean overall work productivity loss due to haemophilia A, grouped by annual bleeding events in the CHESS II study. Among the one hundred fifty-one participants assessed, the chart reports an overall mean loss of twenty-eight point two eight percent, with separate estimates for zero, one, two, three or four, and at least five bleeding events, each accompanied by standard-deviation error bars.

This matters because the study links bleeding burden with work productivity, highlighting an important impact beyond clinical symptoms. These findings came from a retrospective analysis of existing observational CHESS II data, including medical records reported by treating physicians and questionnaires completed by patients in select European countries.

Because the study was retrospective, cross-sectional, and physician- and patient-reported, selection bias, recall bias, and potential data-extraction errors cannot be excluded. The analysis included adults up to age sixty-four but did not include subgroup analysis by age group.

Across this sample, more annual bleeding events were associated with worse quality-of-life and productivity scores. The pattern is important, but the cross-sectional design cannot establish that bleeding caused those outcomes.