Conclusion:

The studies in this journal club demonstrated the effectiveness, both clinically and financially, of  prophylaxis. Another benefit examined in the last two studies is that of academic achievement, and how it relates to prophylaxis. It is well documented in the first three studies, primarily Fischer et al., that prophylaxis started at an early age and continued for life is the optimal treatment modality. However, all studies included here raise the issue of cost vs. benefit, that being the cost of prophylactic therapy vs. the hard benefits of fewer joint bleeds and less arthropathy, and the soft benefits of increased academic achievement and quality of life. 

It would appear that in a perfect world all children diagnosed with hemophilia would begin prophylactic therapy at the age of one year. This being done, benefits would include decreased bleeds resulting in a more normal way of life, increased academic scores, and less joint bleeds and the resulting arthropathy. Unfortunately, the jury is still out as to whether the increased costs of prophylaxis can be justified long-term in our current managed care environment. Further studies are needed to look at both clinical and financial long-term results.