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Cost-effectiveness of a limited-donor blood program for neonatal red cell transfusions
P Hilsenrath1, J Nemechek, J A Widness
1Department of Preventive Medicine, College of Medicine, University of Iowa, Iowa City 52242, USA. peter-hilsenrath@uiowa.edu
Insights
A limited-donor red blood cell (RBC) program for very-low-birthweight infants significantly reduces donor exposures per infant. This approach is cost-effective, especially when excluding white cell reduction costs.
Area of Science:
- Neonatal Medicine
- Transfusion Medicine
- Pediatric Hematology
Background:
- Very-low-birthweight infants traditionally receive fresh red blood cells (RBCs) from multiple donors.
- A shift towards limited-donor programs aims to minimize donor exposure for individual infants requiring long-term transfusion support.
Purpose of the Study:
- To retrospectively assess the costs and effectiveness of a limited-donor program for RBC transfusions in very-low-birthweight infants.
- To compare the costs and donor exposure rates between limited-donor and multiple-donor programs.
Main Methods:
- Retrospective analysis of medical records for very-low-birthweight infants.
- Comparison of costs and donor exposures between two groups of 30 infants from 1993 (multiple-donor) and 1997 (limited-donor).
- Evaluation of effectiveness based on the number of donor exposures per infant.
Main Results:
- The limited-donor program resulted in 2.0 donor exposures per infant, compared to 3.6 in the multiple-donor program (p<0.002).
- Initial cost analysis showed the limited-donor program was more expensive ($34.83 vs. $27.86 per transfusion), primarily due to white cell reduction.
- Excluding white cell reduction costs made the two programs' costs comparable.
Conclusions:
- The limited-donor blood program effectively reduces donor exposure for very-low-birthweight infants.
- This transfusion strategy does not adversely affect overall costs when implemented appropriately.
Background:
Very-low-birthweight infants have typically been given fresh red cells (RBCs), a practice in which aliquots of RBCs for several infants were issued each day from a single unit. Recently, to limit donor exposures, large volumes of RBCs are reserved for the long-term transfusion support of individual infants.
Study Design And Methods:
Medical records were examined retrospectively to assess the costs of a limited-donor program for providing RBC transfusions to very-low-birthweight infants. Costs of multiple- and limited-donor programs were compared by using two samples of 30 consecutive infants treated at The University of Iowa Hospitals and Clinics in 1993 and 1997. Effectiveness was evaluated with respect to the number of donor exposures per infant.
Results:
The cost, in 1997 dollars, of preparing each small-volume transfusion in the multiple-donor program was $27.86 per transfusion, while that in the limited-donor program was $34.83. This difference was largely attributable to use of white cell reduction in association with the limited-donor program in 1997. Eliminating the costs associated with white cell reduction rendered the costs of the limited- and multiple-donor transfusions comparable. The limited-donor program had donor exposures of 2.0 per infant, while the multiple-donor program had 3.6 exposures per infant (p<0.002).
Conclusion:
The limited-donor blood program reduces donor exposure without adversely affecting costs.