Researchers based in Iran developed a service model for patients with severe hemophilia A (PWSHA) and evaluated its use in a study published in the American Journal of Blood Research. Overall, the model proposed by the researchers appeared to show multiple improvements over the current service delivery model.

The researchers aimed to optimize the care delivery model in Tehran, Iran. Hemophilia A management is associated with costs related to factor replacement therapy, and treatment for hemorrhage is often based on a patient’s own perception of pain and hemorrhage. The researchers considered reliance on patient perception to result in diagnostic errors in 63.6% of cases.

Research, development, and assessment of the model occurred in 3 steps. First, the researchers evaluated the current factor VIII (FVIII) delivery model. This evaluation included such aspects as diagnostic protocols, the number PWSHA in Tehran, the process of delivering care, the amount of FVIII needed for each patient, the total FVIII budget within Iran, and emergency management.

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The second step involved actual model development. The researchers considered methods of identifying hemorrhage, optimal timing for bleeding management, geographic distribution of patients across Tehran, and the capacity of care centers, equipment, and caregivers needed. Experts were consulted from a variety of disciplines, ranging from hematologists to traffic engineers. The third step was focused on assessing the acceptability of the model. This was based on questionnaires given to clinicians, health care managers, and patients.

A total of 1660 patients with severe hemophilia A were identified in Tehran in 2018. In Iran, the average use of FVIII was 44,814 unit IU, and the yearly budget for FVIII for Tehran in 2018 was $10,627,320.

The proposed care model for Tehran included 5 care centers. The total service demand was estimated to be 39 service requests per day at each center. In a given day, it was expected that 50% of care would be required between 8 AM and 4 PM, 30% would be required between 4 PM and midnight, and 20% would be needed between midnight and 8 AM, with each service expected to take an average of 1.5 hours. It was expected that 10 trained nurses would be required to staff a center per day, and 3 radiologists would be required. A primary purpose of the radiologist would be to correctly diagnose bleeding. It was estimated that the proposed model would result in an annual savings of $6,412,569, or $3863 per patient.

Assessments of the proposed model indicated support across groups, with satisfaction indicated by patients, clinicians, and health care managers. According to questionnaires, 96% of patients expected the model to reduce side fees, such as travel costs, and 98% considered the model’s processes to be suitable, with 100% considering the model to be logical and appropriate.

“Our proposed model can effectively cover most of the existing home care model defects, improve the quality of life of the PWSHA, and save a significant amount of budget successfully,” the researchers concluded in their report.


Davari M, Sadeghi A, Gharibnaseri Z, Ravanbod R, Eshghi P, Zargaran M. An efficient and effective ambulatory service model for severe hemophilia-A patients; an introduction to a novel home care model. Am J Blood Res. 2021;11(5):520-527.