Evolution of Hemophilia Management in Italy: Results from a Delphi Consensus Study

Background/Objectives: The clinical management of hemophilia has evolved with the introduction of innovative therapies that are reshaping treatment paradigms. Real-world implementation of these approaches may vary across centers. This modified Delphi consensus study aimed to explore current clinical perspectives on hemophilia management in Italy among healthcare professionals. Methods: Eight hemophilia experts developed 38 statements covering seven domains, including therapeutic personalization, adherence and patient engagement, follow-up strategies, inhibitor management, comorbidity management in patients, musculoskeletal monitoring, and organizational aspects of care. Statements were evaluated through an anonymous web-based survey in a modified single-round Delphi process using a 5-point Likert scale. Consensus was defined a priori as ≥70% agreement or disagreement after exclusion of neutral responses. Results: Thirty-four clinicians from specialized hemophilia centers participated in the survey. Strong agreement emerged regarding the importance of personalized treatment strategies, active patient involvement in therapeutic decisions, and multidisciplinary management, particularly in ageing patients with comorbidities. Panelists also supported the role of joint ultrasound in monitoring musculoskeletal health and highlighted adherence as a key determinant of treatment outcomes. Areas of heterogeneity included criteria for transitioning between intravenous and subcutaneous therapies, the implementation of structured transition programs from pediatric to adult care, and the frequency of musculoskeletal imaging. Limited availability of psychological support and variable integration of patient-reported outcomes were also identified. Conclusions: Italian hemophilia specialists showed substantial agreement across key domains; however, future work should address remaining organizational and clinical gaps and incorporate patient perspectives to support more integrated and patient-centered management strategies for people with hemophilia.