Cost implications of implementation of pathogen‐inactivated platelets

Abstract

BACKGROUNDPathogen inactivation (PI) is a new approach to blood safety that may introduce additional costs. This study identifies costs that could be eliminated, thereby mitigating the financial impact.STUDY DESIGN AND METHODSCost information was obtained from five institutions on tests and procedures (e.g., irradiation) currently performed, that could be eliminated. The impact of increased platelet (PLT) availability due to fewer testing losses, earlier entry into inventory, and fewer outdates with a 7-day shelf life were also estimated. Additional estimates include costs associated with managing 1) special requests and 2) test results, 3) quality control and proficiency testing, 4) equipment acquisition and maintenance, 5) replacement of units lost to positive tests, 6) seasonal or geographic testing, and 7) health department interactions.RESULTSAll costs are mean values per apheresis PLT unit in USD ($/unit). The estimated test costs that could be eliminated are $71.76/unit and a decrease in transfusion reactions corresponds to $2.70/unit. Avoiding new tests (e.g., Babesia and dengue) amounts to $41.80/unit. Elimination of irradiation saves $8.50/unit, while decreased outdating with 7-day storage can be amortized to $16.89/unit. Total potential costs saved with PI is $141.65/unit. Costs are influenced by a variety of factors specific to institutions such as testing practices and the location in which such costs are incurred and careful analysis should be performed. Additional benefits, not quantified, include retention of some currently deferred donors and scheduling flexibility due to 7-day storage.CONCLUSIONSWhile PI implementation will result in additional costs, there are also potential offsetting cost reductions, especially after 7-day storage licensing.

Financial impact of alternative approaches to reduce bacterial contamination of platelet transfusions

“…The analysis also focused on bacterial contamination only and did not account for potential effects of these approaches on nonbacterial infections. It has been shown that PR can effectively inactivate cytomegalovirus and West Nile virus, among certain other viruses and parasites, and would be expected to eliminate additional costs associated with these tests . Incorporating these additional pathogens would be expected to increase overall costs for the baseline strategy, PORt, and SBC.…”

“…Incorporating these additional pathogens would be expected to increase overall costs for the baseline strategy, PORt, and SBC. However, averted costs from not needing to test for these additional pathogens are small, relative to the cost of PR itself …”

Impact of implementing pathogen reduction technologies for platelets on reducing outdates

“…Numerous papers have analysed the financial cost of implementing PRT . One important aspect of the savings to be made by extending the shelf life of PC to 7 days is the reduction in the number of units discarded due to outdating.…”

Current strategies and future directions for the prevention of transfusion-transmitted cytomegalovirus

“…92 The use of PITs will certainly increase the cost of blood products, but this increase in cost is expected to be partially offset by the elimination of the need for irradiation and several types of infectious disease testing (eg, CMV, West Nile virus, and bacterial culture) in pathogen-reduced blood products. 88 Although important questions remain in regard to implementation, PITs will likely end the long-running debate as to whether the addition of CMV-seronegativity to blood products that are already leukoreduced is necessary for optimal prevention of TT-CMV infection. …”

“…It also decreases the risk of transfusion-associated graft versus host disease through the inactivation of donor leukocytes, possibly obviating the need for irradiation of blood products in at-risk patients. 87,88 Although a licensed pathogen inactivation system is not yet available for red blood cells, the development of such a technology is in progress that uses S-303, a frangible anchor linker effector compound that crosslinks nucleic acids, and glutathione as a quencher to minimize the interaction of S-303 with plasma proteins. 89,90 Adaptation of the riboflavin/ UV method of pathogen inactivation for packed red blood cells and whole blood is also underway.…”