1

I costi trasfusionaliTransfusional costs

Giovanni InghilleriServizio di Immunoematologia e Medicina

Trasfusionale

A.O. Fatebenefratelli e OftalmicoMilan – Italy

2

Shortcomings of the current health care systems

Dr. Orszag is the director of the Congressional Budget Office (CBO), a nonpartisan agency that provides budgetary and economic analyses to Congress.

3

“Blood has become a scarse and costly resource”

• Doctors are required to deal with the costs of clinical strategies utilized;

• Blood banks have to optimize the blood components production;

• Health providers have to decide how to allocate the limited funds in health care system

• Cost-effectiveness and cost-benefit data should be the base for any decision making (particularly when “alternatives” have to be compared) .

Costs of blood transfusion

In a period characterized by worldwide economic crisis knowledge on costs of blood components and blood transfusion process is of paramount importance:

5

“Problems” in cost evaluations of blood:

• Cost analysis;• Economic

evaluations:– Cost-benefit study– Cost-effectiveness

study– Cost-Utility study

Costs of blood transfusion

Different type of analysis can be performed :

Transfusion , 2014 Aug; 54(8): 2034-44

6

“Problems” in cost evaluations of blood:

• Patient;• Blood Bank• Department/Hospital• National Healths

System• Society

Costs of blood transfusion

Economic studies can be performed taking into account different “perspective”:

7

Topic of this presentation:

• Cost of Blood Components • Cost of Transfusion of Blood component

(RBcs);

Costs of blood transfusion

To focus attention on cost-analysis studies on:

Taking primarily into considerations the perspective of the departments and hospitals

8

The cost of blood and blood component

Costs of blood transfusion

‘Safety at all costs’ remains the societal position on the importance of a safe blood supply.

9

10

The cost of blood and blood componentCosts of blood transfusion

Blood Components PriceRBCs Concentrate (280mL+ 20%) 153,00Plasma frozen within 6 hours (250mL + 20%) 20,00FFP from apheresis (> 500 mL) 161,00Whole-blood derived platelets (0,6x1011 plt) 23,00Platelets pool from buffy-coat (2,5x1011 plt) 115,00Apheresis Platelet (3,0 x1011 plt) 438,00

Special treatments PriceBC removal 5,00In line filtration 40,00Cell washing 80,00

Irradiation 38,00

11

1£ = 1.37 (1.35-1.40) €

≈ 170€

The cost of blood and blood component

Costs of blood transfusion

(Leucocyte filtered)

12

The cost of blood and blood componentCosts of blood transfusion

≈ 285 €

≈ 37 €1£ = 1.37 (1.35-1.40) €

13

≈ 205 €

≈ 52 €

14

15

It is the total cost of blood, accounting for all the process involved in administering a unit of blood, in addiction to the cost of blood component:

– transfusion request, informed consent procedure, collecting blood sample, pretransfusion tests, delivering of blood component, adminstration of blood transfusion, monitoring, management of adverse events.

Cost estimates of the blood transfusion process are of great value but are difficult and require precise methods and high standardization.Most of the studies evaluated the cost of RBC administration

The cost of blood transfusion

Costs of blood transfusion

16

The Society for the Advancement of Blood Management (SABM) proposed and assembled a consensus conference to help define appropriate methodology: Activity-Based Cost model

17

STUDY DESIGN AND METHODS: • An activity-based costing (ABC) model was constructed; • Tasks and resource consumption (materials, labor, third-party services,

capital) related to blood administration were identified prospectively at two US and two European hospitals;

• Data collected in the surgical setting;• Follow-up of acute transfusion-related reactions was included;• Treatment of long-term complications and rehabilitation associated with

a transfusion-transmissible disease, litigation, and reimbursement or indemnification for adverse events were omitted;

• The impact of transfusions on hospital length of stay was also not evaluated.

Up to Feb 2015,135 citing articles in CrossRef

Up to Feb 2015,135 citing articles in CrossRef

18

• Englewood Hospital Medical Center (EHMC; Englewood, NJ),

• Rhode Island Hospital (RIH; Providence, RI),

• Centre Hospitalier Universitaire Vaudois (CHUV; Lausanne, Switzerland),

• General Hospital Linz (AKH; Linz, Austria),

Mean total cost per RBC unit was $760.82 + 293.74

19

1183 $/U 702 $/U

611 $/U

726 $/U

522 $/U

428 $/U

409 $/U 355 $/U

20

21

Conclusions• Blood is actually a scarse and costly resource;• The cost of 1 unit of RBC is in the range of 130-180 € in

most of the Countries (higher variability occurs for FFP and PLTs);

• The cost of the transfusion of 1 unit of RBC is much higher, at least 2-4 fold the cost of acquisition;

• Appropriate use of blood components is the key for their cost/effectiveness.

• Alternative strategies to blood transfusion could allow not only to improve the patients safety but also “to save” money.

Costs of blood transfusion

22

The cost of blood and blood componentHow much is the actual cost of blood transfusion?

23

The cost of blood and blood componentHow much is the actual cost of blood transfusion?