Assessment of the economic value of the INTERCEPT blood system in Belgium

Abstract

Emerging pathogens continue to threaten blood safety, requiring novel safety approaches. INTERCEPT Blood System for platelets (IBSP) inactivates pathogens, aiming at eliminating the risk of transmitting current and emerging pathogens. The objective was to evaluate the incremental cost-effectiveness ratio (ICER) for IBSP in Belgium. A decision model comparing a 'world with IBSP' to a 'world without IBSP' calculates lifetime costs and 'quality adjusted life years' (QALYs) following platelet transfusion in different indications. Disease-specific life expectancy and consequences of transfusion-transmitted infections were obtained from literature. Transfusion safety and costs were obtained from official sources. Hepatitis C virus-like emerging pathogen was simulated. A wide range of ICERs was observed, highly sensitive to the risk of emerging pathogen trans- mission, underlying disease and age. In the most conservative approach, ICER ranged from 3,459,201 Euro/QALY in absence of emerging pathogen to 195,364 Euro/QALY. The mean threshold of emerging infection risk for IBSP dominance (saving money and producing health gains) ranged from 1/1,079 to 1/2,858 transfusions. Considering the high value authorities appear to place on preventing accidental injury, and ICER of recent implementations in transfusion medicine (NAT: up to 2.3 million Euro per lifeyear), IBSP can be considered cost-effective, taking into account the potential risk of emerging pathogens.

Model Calculations to Quantify Clinical and Economic Effects of Pathogen Inactivation in Platelet Concentrates

“…A cost increase of € 50 per PC lies in between the estimated additional costs from cost effectiveness analyses for PI in various countries [29,30,31]. These models refer to known risks of bacterial and viral infections and the respective disease consequences or to potential infectious risks of re-/emerging pathogens transmissible by PCs, which would all be avoided by PI.…”

“…These models refer to known risks of bacterial and viral infections and the respective disease consequences or to potential infectious risks of re-/emerging pathogens transmissible by PCs, which would all be avoided by PI. In the context of costs for other accepted blood safety interventions in the developed world, PI for PCs appears to be cost-effective to most authors [29,30,31]. …”

“…However, assuming a mean wastage rate of 12% in German centres producing apheresis platelets (Junicon ® , 2009, personal communication) the average wastage rate would drop by approximately 2-5% because of the prolongation of shelf-life by 1 day accompanied by savings accordingly. This estimation is, however, based on Belgian data [29]. …”

Pathogen reduction/inactivation of products for the treatment of bleeding disorders: what are the processes and what should we say to patients?

“…In a Belgian study, implementation of an amotosalen-based pathogen reduction system for platelets was found to be cost-effective compared with the initial national system (measured in terms of lifetime costs and quality adjusted life years (QALYs)). A range of incremental cost-effectiveness ratios were observed (in absence of emerging pathogens) from 3,459,201 €/QALY to 195,364 €/QALY), and the mean threshold of emerging infection risk for the pathogen reduction system ranged from 1/1079 to 1/2858 transfusion [124]. In addition, a model that was developed from a Dutch study found that implementation of pathogen inactivation as a routine procedure would be a cost-effective measure (measuring cost-effectiveness in net costs per life year gained (LYG)); net costs per LYG with pathogen inactivation were estimated at €554,000 in the baseline-weighted average over three patient groups (90% simulation interval €354,000–1092,500).…”

Pathogen inactivation: making decisions about new technologies

“…The Panel appreciates that precaution must be tempered by the logic of cost‐benefit analysis with its focus on scarcity and estimates of risk 65 . Country‐specific studies of different PI technologies have been published, and the strengths and limitations of the existing studies were analyzed at this conference 66‐72 . Economic evaluations of all PI procedures should be conducted.…”