Expensive blood safety technologies: understanding and managing cost and access-to-care issues

With a succession of recent blood safety enhancements driving up blood component costs for their hospital customers, the blood banking industry has called for changes in Medicare inpatient payment policy to narrow the gap between costs and reimbursement. In the specific case of leukoreduction of red blood cells, the interplay of intense cost pressures and the absence of authoritative clinical practice guidelines have created wide hospital-to-hospital disparities in patient access to leukoreduced blood components. This review examines the financial implications of costly nonmandated blood safety-related technologies for US hospitals, using leukoreduced red blood cells as a case example. An approach is offered to (1) standardize clinical practice with respect to the administration of nonmandated blood component innovations, (2) reduce the influence of hospital financial priorities on patient access, and (3) better address medicoeconomic tradeoff concerns.