Such constructs selleck kinase inhibitor lead to complex instruments that are a challenge for both patients and those administering it. Language and social context related issues also require its adaptation and validation in different parts of the world [55, 56]. More importantly, what really needs to be evaluated is whether the information collected adds to the management of the individual or in comparison of cohorts beyond what is obtained from the assessment tools described above. hrQOL instruments often tend to be less sensitive to smaller differences in outcome assessments and this can lead to difficult conclusions. In one recent analysis comparing the value

of prophylaxis over episodic replacement therapy, it was concluded that there is not enough evidence to justify prophylaxis based on hrQOL data [57]. Therefore, it is not only important to use an appropriate hrQOL instrument but to also ensure that these are not administered in isolation but only as an adjunct to more specific assessment of bleeding, joint status Akt inhibitor and activities. One will then need to decide whether hrQOL assessment is indeed providing data that has incremental value in the management of these patients or in healthcare planning. As we attempt to move towards collecting data on outcomes, one of the lacunae in the field is the lack

of definitions of specific complications or the response to therapies. In fact, except for the severity of haemophilia and the high- and low-titre inhibitors, there were in the past no other definitions in haemophilia [58]. Even joints and muscle bleeds and the titre at which to consider inhibitors significant are not defined. All these are of vital importance in pivotal studies for assessment of CFC as well as Pregnenolone for the long-term assessments of PWH. An ISTH SSC group has recently provided these definitions, along with those for types of prophylaxis and assessment of after acute haemarthrosis and surgical haemostasis [59]. Another group is working on definitions of endpoints in clinical studies

[60]. All these will help in better study designs and outcomes data collection. Another hurdle to significant data collection in the past has been the lack of cooperative groups. This prevented data from being pooled and analysed as large cohorts. Over the past few years, this is changing. There are now several efforts towards cooperative data collection. One of the oldest, is the PEDNET group in Europe, a collaboration of 30 centres in 16 countries [61]. A system of well-defined data collection established nearly 15 years ago, has now led to a very robust database which has allowed some very important conclusions to be drawn, particularly with regard to inhibitors in previously untreated patients as well as other aspects of haemophilia management.