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Updated: Jul 15, 2026
Continuous Manual Exchange Transfusion for Patients with Sickle Cell Disease: An Efficient Method to Avoid Iron Overload
Published on: March 14, 2017
Financial analysis of chronic transfusion for stroke prevention in sickle cell disease
A S Wayne1, S E Schoenike, C H Pegelow
1Department of Pediatrics, Division of Pediatric Hematology Oncology, Sickle Cell Center, and Pediatric Pharmacy Department, University of Miami School of Medicine, Jackson Memorial Medical Center, Miami, FL, USA. waynea@mail.nih.gov
Insights
Chronic red blood cell transfusions prevent sickle cell disease complications but incur significant medical costs, particularly for iron overload management. This study quantifies the substantial financial burden of these transfusions, impacting treatment decisions.
Area of Science:
- Hematology
- Medical Economics
Background:
- Chronic red blood cell transfusions are vital for managing sickle cell disease manifestations.
- Managing transfusions involves significant costs, especially addressing iron overload side effects.
Purpose of the Study:
- To evaluate the financial impact of chronic transfusion therapy for stroke prevention in sickle cell anemia patients.
- To analyze outpatient charges, including hospital fees, professional services, and iron chelation.
Main Methods:
- Retrospective analysis of 21 sickle cell anemia patients over 296 patient months.
- Evaluation of Medicare uniform bill (UB-92) codes, physician fees, and iron chelation costs.
- Categorization of charges into hospital-based, chelation, and physician-related components.
Main Results:
- Annual charges ranged from $9,828 to $50,852 per patient.
- Hospital charges (UB-92) constituted 53%, followed by chelation (42%) and physician fees (5%).
- Patients requiring deferoxamine chelation incurred annual costs between $31,143 and $50,852.
Conclusions:
- Chronic transfusion therapy for sickle cell disease presents a substantial financial burden, nearing $400,000 per patient decade with deferoxamine.
- These economic data are crucial for cost-effectiveness analyses of alternative sickle cell disease treatments like bone marrow transplantation.
Abstract:
Chronic red blood cell transfusion can prevent many of the manifestations of sickle cell disease. The medical costs of chronic transfusion and management of associated side effects, especially iron overload, are considerable. This study was undertaken to evaluate the financial impact of chronic transfusion for stroke prevention in patients with sickle cell anemia. Outpatient charges pertaining to hospital-based Medicare uniform bill (UB-92) codes, professional fees, and iron chelation were evaluated. Data were collected on 21 patients for a total of 296 patient months (mean, 14; median, 14 months/patient). Charges ranged from $9828 to $50 852 per patient per year. UB-92, chelation, and physician-related charges accounted for 53%, 42%, and 5% of total charges, respectively. Of UB-92 charges, 58% were associated with laboratory fees and 16% were related to the processing and administration of blood. Charges for patients who required chelation therapy ranged from $31 143 to $50 852 per patient per year (mean, $39 779; median, $38 607). Deferoxamine accounted for 71% of chelation-related charges, which ranged from $12 719 to $24 845 per patient per year (mean, $20 514; median, $21 381). The financial impact of chronic transfusion therapy for sickle cell disease is substantial with charges approaching $400 000 per patient decade for patients who require deferoxamine chelation. These data should be considered in reference to cost and efficacy analyses of alternative therapies for sickle cell disease, such as allogeneic bone marrow transplantation.
