The cost of blood: a study of the total cost of red blood cell transfusion in patients with β‐thalassemia using time‐driven activity‐based costing

Abstract

BACKGROUND: To accurately quantify the costs of care for patients with transfusion-dependent thalassemia (TDT), and to evaluate cost-effectiveness of new treatments, data are required on costs of regular red blood cell (RBC) transfusions. However, no previous studies have evaluated the costs of RBC transfusion specifically in chronically transfused patients. P atients with transfusion-dependent thalassemia (TDT) require lifelong, regular red blood cell (RBC) transfusions to improve anemia and to suppress ineffective erythropoiesis and subsequent complications, such as splenomegaly, skeletal abnormalities, increased dietary iron absorption, and thrombosis. 1,2 Transfusing RBCs every 2 to 5 weeks has been shown to maintain the balance between inhibition of erythropoiesis and transfusion-related iron overload. 2 Allogeneic stem cell transplantation is the only current definitive cure for TDT; however, this procedure is limited by availability of matched donors and the risk of graft-versus-host disease. Encouragingly, many new therapeutic approaches with potential to transform management of β-thalassemia are currently being evaluated in clinical trials. ABBREVIATIONS: MMC = Monash Medical Centre; MTU = Medical Therapy Unit; TDABC = time-driven activity-based costing; TDT = transfusion-dependent thalassemia. From the

Red cell transfusions: Is less always best?

“…39 In a detailed activity-based costing study of transfusiondependent thalassemia patients receiving outpatient transfusion, it was estimated that the product cost of an RBC unit contributed to less than half of the total cost of administering the transfusion. 65 Apart from the direct cost of transfusion (blood product cost, hospital/staffing costs, diagnostic tests, and patients' travel expenses) there are also other significant indirect costs that need to be considered in chronic disease, 66 such as the costs of reduced productivity and QoL due to symptoms of anemia or the transfusion treatment. Although health economics analyses of transfusion practice may not be broadly generalizable to all countries, given the differences in healthcare and funding models in different countries, this information may still be helpful as a starting point to enable local jurisdictions to perform their own analyses and incorporate health economics analyses into clinical trials.…”

“…In the REDDS trial in MDS patients, the liberal group used double the number of RBC units compared to the restrictive group over the 12‐week treatment period 39 . In a detailed activity‐based costing study of transfusion‐dependent thalassemia patients receiving outpatient transfusion, it was estimated that the product cost of an RBC unit contributed to less than half of the total cost of administering the transfusion 65 . Apart from the direct cost of transfusion (blood product cost, hospital/staffing costs, diagnostic tests, and patients' travel expenses) there are also other significant indirect costs that need to be considered in chronic disease, 66 such as the costs of reduced productivity and QoL due to symptoms of anemia or the transfusion treatment.…”

Gene Therapy of the Hemoglobinopathies

“…The expenses for red blood cell transfusions and for iron chelation are estimated to exceed €30,000 annually for an adult patient. 8 , 13 …”

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“…For example, a recent time-driven activity-based costing study of Australian red cell use reveals that the average production cost of a unit of red blood cells is US$278.35, and, with transfusion, it costs US$695.59. 102 Current WB product is collected from only male donors to reduce the risk of transfusion-related acute lung injury. Group O Rhþ is used because Rh-is always in demand.…”

“…For all the aforementioned considerations, these units are now being priced at a premium, which is now approximately US$300 at a cross-section of university and community hospitals. 58,102,108 However, the greater expense in WB transfusions comes once the product is received at the hospital with the retyping of the unit, storage, and administration. Abbreviations: BCT, blood component therapy; CMV, cytomegalovirus; CSWB, cold-stored whole blood; FNHTR, febrile nonhemolytic transfusion reactions; GVHD, graft-versus-host disease; HLA, human leukocyte antigen; LTOB, low-titer group O blood; LTOFWB, low-titer group O fresh whole blood; PRBCs, packed red blood cells; RCTs, randomized controlled trials; WB, whole blood; WBCs, white blood cells.…”