Outpatient red blood cell transfusion payments among patients on chronic dialysis

Abstract

BackgroundPayments for red blood cell (RBC) transfusions are separate from US Medicare bundled payments for dialysis-related services and medications. Our objective was to examine the economic burden for payers when chronic dialysis patients receive outpatient RBC transfusions.MethodsUsing Truven Health MarketScan® data (1/1/02-10/31/10) in this retrospective micro-costing economic analysis, we analyzed data from chronic dialysis patients who underwent at least 1 outpatient RBC transfusion who had at least 6 months of continuous enrollment prior to initial dialysis claim and at least 30 days post-transfusion follow-up. A conceptual model of transfusion-associated resource use based on current literature was employed to estimate outpatient RBC transfusion payments. Total payments per RBC transfusion episode included screening/monitoring (within 3 days), blood acquisition/administration (within 2 days), and associated complications (within 3 days for acute events; up to 45 days for chronic events).ResultsA total of 3283 patient transfusion episodes were included; 56.4% were men and 40.9% had Medicare supplemental insurance. Mean (standard deviation [SD]) age was 60.9 (15.0) years, and mean Charlson comorbidity index was 4.3 (2.5). During a mean (SD) follow-up of 495 (474) days, patients had a mean of 2.2 (3.8) outpatient RBC transfusion episodes. Mean/median (SD) total payment per RBC transfusion episode was $854/$427 ($2,060) with 72.1% attributable to blood acquisition and administration payments. Complication payments ranged from mean (SD) $213 ($168) for delayed hemolytic transfusion reaction to $19,466 ($15,424) for congestive heart failure.ConclusionsPayments for outpatient RBC transfusion episodes were driven by blood acquisition and administration payments. While infrequent, transfusion complications increased payments substantially when they occurred.

Effects of the prospective payment system on anemia management in maintenance dialysis patients: implications for cost and site of care

“…Using previously published [ 5 , 8 ] methods, we searched Medicare claims for outpatient transfusions and related services, including transfusion-related adverse events. No attempt was made to determine the specific indication for transfusion.…”

“…These services included pre- and post-transfusion screening (antibody, chemistry, hematology, immunology) within 3 days before and after the transfusion, and acquisition and administration of blood products and storage. We also identified transfusion-related adverse events, including febrile non-hemolytic reaction, hemolytic reaction, air embolism, phlebitis, hyperkalemia, allergic reaction, congestive heart failure (CHF), transfusion-related lung injury, and transfusion related circulatory overload [ 8 ], within 3 days of the transfusion and delayed hemolytic reaction within 45 days. CHF hospitalizations were included as adverse events only for patients with no other CHF-related episodes in the 6 months before the transfusion.…”

Recurrent hospitalization and healthcare resource use among patients with deep vein thrombosis and pulmonary embolism: findings from a multi-payer analysis

“…The Clinformatics™ DataMart database, a product of OptumInsight Life Sciences, Inc. (Eden Prairie, MN), consists of a single, large insurance healthcare plan that includes more than 53 million unique members spanning over 12 years. The Truven MarketScan ® Commercial Claims and Encounter Database is constructed from privately insured paid medical and prescription drug claims for approximately 30 million employees and their dependents (in 2010) [ 14 ]. The MarketScan Medicare Supplemental Database contains the healthcare experience of individuals with Medicare supplemental insurance paid by employers for approximately 3.42 million retirees (in 2010) [ 14 ].…”

“…The Truven MarketScan ® Commercial Claims and Encounter Database is constructed from privately insured paid medical and prescription drug claims for approximately 30 million employees and their dependents (in 2010) [ 14 ]. The MarketScan Medicare Supplemental Database contains the healthcare experience of individuals with Medicare supplemental insurance paid by employers for approximately 3.42 million retirees (in 2010) [ 14 ]. The Humana database consists of the entire fully-insured commercial and Medicare members belonging to the Humana health plan.…”

Red blood cell (RBC) transfusion rates among US chronic dialysis patients during changes to Medicare end-stage renal disease (ESRD) reimbursement systems and erythropoiesis stimulating agent (ESA) labels

“…In previous work, we showed that while infrequent, payments for RBC transfusion complications were very high when complications occurred; mean payments for complications ranged from $213 (SD = $168) for delayed hemolytic transfusion reactions to $19,466 (SD = $15,424) for congestive heart failure [21]. Additionally, RBC transfusions can result in sensitization to human leukocyte antigen (HLA), which reduces the opportunity for future kidney transplantation [29].…”