Laboratory costs of a hospital-based blood transfusion service in Malawi

Abstract

Background: Despite policies advocating centralised transfusion services based on voluntary donors, the hospital-based replacement donor system is widespread in sub-Saharan Africa. Aims: To evaluate the cost of all laboratory resources needed to provide a unit of safe blood in rural Malawi using the family replacement donor system Methods: Full economic costs of all laboratory tests used to screen potential donors and to perform crossmatching were documented in a prospective, observational study in Ntcheu district hospital laboratory. Results: 1729 potential donors were screened and 11 008 tests were performed to ensure that 1104 units of safe blood were available for transfusion. The annual cost of all transfusion-related tests (in 2005 US$) was $17 976, equivalent to $16.28 per unit of transfusion-ready blood. Transfusion-related tests used 53% of the laboratory's total annual expenditure of $33 608. Conclusions: This is the first study to provide prospective economic costs of all laboratory tests associated with the family replacement donor system in a district hospital in Africa. Results show that despite potential economies of scale, a unit of blood from the centralised system costs about three times as much as one from the hospital-based ''replacement'' system. Factors affecting these relative costs are complex but are in part due to the cost of donor recruitment in centralised systems. In the replacement system the cost of donor recruitment is entirely borne by families of patients needing a blood transfusion.

Costing of Malaria treatment in a rural district hospital

“…at the laboratory 44 different tests. Cost for each of them were calculated by the ingredient's approach, where the final price is the product of the quantity of inputs used and their value per unit [22,23]. This means that wherever possible cost were directly allocated to a specific laboratory test (staff costs per minute, equipment, consumption material) only overhead cost (electricity, building etc.)…”

Maternal mortality in sub‐Saharan Africa: the contribution of ineffective blood transfusion services

“…56 In Ghana, predonation screening for serological markers of HIV, hepatitis B and hepatitis C reduced wastage of blood bags, 57 which are the most expensive component of a hospital-based transfusion service. 58 Costly hepatitis C tests were conserved in Namibia by restricting their use to first time donors, 59 and in Malawi the order of five screening tests was adjusted so that the cheapest test was used first, thereby restricting expensive tests to samples that were negative for other tests. 60 In a 7-year programme in Tanzania, the introduction of 22 different interventions that included a vigorous blood donor campaign and strict transfusion guidelines, reduced maternal mortality from 933 to 186/100 000 live births.…”

Female Gender Participation in the Blood Donation Process in Resource Poor Settings: Case study of Sokoto in North Western Nigeria

“…Being expected to provide replacement donors puts additional responsibility and stress on relatives, and there is undue pressure on family members to give blood, even when they know that donating blood may affect their own health or that they may be potentially at risk of transmitting TTIs [60,61]. A country's transfusion needs cannot easily be met by relying solely on family replacement donations [62]. The World Health Assembly recommended that reliance on replacement donations should be phased out due to their association with an increased risk of TTIs [63].…”