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Economic Implications of Pathogen Reduced and Bacterially Tested Platelet Components: A US Hospital Budget Impact
Katherine M Prioli1, Julie Katz Karp2, Nina M Lyons3
1Center for Health Outcomes, Policy, and Economics, Rutgers University, 160 Frelinghuysen Road, Suite 417, Piscataway, NJ, 08854, USA.
Background:
US FDA draft guidance includes pathogen reduction (PR) or secondary rapid bacterial testing (RT) in its recommendations for mitigating risk of platelet component (PC) bacterial contamination. An interactive budget impact model was created for hospitals to use when considering these technologies.
Methods:
A Microsoft Excel model was built and populated with base-case costs and probabilities identified through literature search and a survey of US hospital transfusion service directors. Annual costs of PC acquisition, testing, wastage, dispensing/transfusion, sepsis, shelf life, and reimbursement for a mid-sized hospital that purchases all of its PCs were compared for four scenarios: 100% conventional PCs (C-PC), 100% RT-PC, 100% PR-PC, and 50% RT-PC/50% PR-PC.
Results:
Annual total costs were US$3.64, US$3.67, and US$3.96 million when all platelets were C-PC, RT-PC, or PR-PC, respectively, or US$3.81 million in the 50% RT-PC/50% PR-PC scenario. The annual net cost of PR-PC, obtained by subtracting annual reimbursements from annual total costs, is 6.18% above that of RT-PC. Maximum usable shelf lives for C-PC, RT-PC, and PR-PC are 3.0, 5.0, and 3.6 days, respectively; hospitals obtain PR-PC components earliest at 1.37 days.
Conclusion:
The model predicts minimal cost increase for PR-PC versus RT-PC, including cost offsets such as elimination of bacterial detection and irradiation, and reimbursement. Additional safety provided by PR, including risk mitigation of transfusion-transmission of a broad spectrum of viruses, parasites, and emerging pathogens, may justify this increase. Effective PC shelf life may increase with RT, but platelets can be available sooner with PR due to elimination of bacterial detection, depending on blood center logistics.
Insights
Pathogen reduction (PR) and rapid bacterial testing (RT) mitigate platelet bacterial contamination risk. While PR-PC has a slightly higher net cost, it offers broader safety benefits and faster availability than conventional or RT-PC.
Area of Science:
- Transfusion Medicine
- Microbiology
- Health Economics
Background:
- US FDA guidance recommends pathogen reduction (PR) or rapid bacterial testing (RT) to reduce bacterial contamination in platelet components (PC).
- Hospitals need tools to evaluate these risk mitigation technologies.
Purpose of the Study:
- To compare the budget impact of PR-PC and RT-PC for hospitals.
- To analyze costs associated with different platelet component strategies.
Main Methods:
- An interactive budget impact model was developed using Microsoft Excel.
- Costs and probabilities were sourced from literature and a survey of US hospital transfusion directors.
- Annual costs were compared for four scenarios: conventional PCs (C-PC), 100% RT-PC, 100% PR-PC, and a 50% RT-PC/50% PR-PC mix.
Main Results:
- Total annual costs were $3.64M (C-PC), $3.67M (RT-PC), $3.96M (PR-PC), and $3.81M (50% RT-PC/50% PR-PC).
- Net cost of PR-PC was 6.18% higher than RT-PC after accounting for reimbursements.
- Shelf lives were 3.0 days (C-PC), 5.0 days (RT-PC), and 3.6 days (PR-PC); PR-PC availability was earliest at 1.37 days.
Conclusions:
- PR-PC shows minimal cost increase over RT-PC, with offsets from reduced testing and irradiation, plus reimbursement.
- Enhanced safety from PR, including mitigation of transfusion-transmitted pathogens, may justify the cost.
- PR-PC offers faster availability, while RT-PC may offer a longer shelf life, depending on logistics.
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