Cost-effectiveness of a hypothetical assay to evaluate stored blood quality prior to transfusion

Unsuccessful red blood cell (RBC) transfusion, necessitating unscheduled repeat transfusion, is common and costly. Several technologies have been developed to assess stored blood quality, but the potential cost-effectiveness of pretransfusion testing versus no testing to prevent unscheduled re-transfusion is unknown.

Projected benefits and costs of implementing a hypothetical pretransfusion assay were evaluated using Markov models with 10,000 Monte Carlo simulations. Chronic RBC transfusions were modelled at 1-month intervals over a 1-year time horizon, for 'simple' and 'complicated' (requiring antigen matching) cohorts. Model inputs included transfusion costs and quality-of-life weights. Cost-effectiveness was defined as incremental net monetary benefit (INMB) > 0, assuming willingness to pay <$50,000 per quality-adjusted life year (QALY).

The Centers for Medicare and Medicaid Services reimbursement for a single-unit RBC transfusion was $970 ($853-$1313) and $2377 ($2057-$3317), respectively, for the simple and complicated cohorts. The hypothetical assay was priced at $100 ($38-$163) and was assumed to lower unscheduled re-transfusions by 30%, from 64% to 45% (40%-50%). Pretransfusion testing yielded 0.02 higher QALY (95% prediction interval [PI]: 0.01-0.02); annual per-patient cost savings of $269 (95% PI: $263-$276) and $3651 (95% PI: $3633-$3669), respectively, for the simple and complicated cohorts; and INMB of $1083 (95% PI: $985-$1180) and $4347 (95% PI: $4250-$4443).

Assessment of RBC quality by a hypothetical test prior to transfusion may reduce the incidence and associated costs of unscheduled re-transfusions and, with modelled assumptions, could be especially cost-effective for patients with complicated chronic transfusion requirements.