A critical analysis of adult platelet product utilisation in South Africa, 2014 - 2021

Platelet products are usually prescribed for the prevention and treatment of bleeding in patients with reduced platelet counts, or those with dysfunctional platelets. Between 2008 and 2017, platelet use across 12 multinational transfusion centres increased by 10.2%, and a further increase of 3.9% is predicted by 2032. The National Health Insurance (NHI) Bill has been signed into South African (SA) law, starting the transition from a two-tiered healthcare system to universal access to healthcare. Healthcare sector-specific platelet recipient and utilisation profiles for SA are largely unknown. Quantifying differences in utilisation patterns between the SA healthcare sectors is essential for long-term planning, and to provide valuable insights to inform policy.

To critically analyse platelet utilisation patterns at the South African National Blood Service (SANBS) according to SA healthcare sector.

The SANBS provides blood products to eight out of the nine provinces in SA. We conducted a descriptive, cross-sectional, retrospective analysis of all platelet requisitions processed by the SANBS between 1 January 2014 and 31 December 2021. Healthcare sector- specific demographic and utilisation patterns were determined, and per capita utilisation calculated.

Of the 445 803 platelet units issued in the specified time period, 200 856 (45.1%) were issued to the public sector, compared with 244 922 (54.9%) to the private sector. The public sector recipients were mostly female (55.7%), with a median (interquartile range (IQR)) age of 29 (15 - 42) years, and in the private sector, mostly male (53.1%), with a median (IQR) age of 53 (36 - 65) years. The private sector issued more units of platelets per 1 000 population on average than the public sector, with 3.89 units per 1 000 private sector population v. 0.59 units per 1 000 public sector population.

Platelet utilisation between SA's healthcare sectors is distinctly different. The drivers underpinning these patterns are interdependent, including population and demographic characteristics, disease patterns, transfusion practices and healthcare demands. A greater understanding of socioeconomic and disease drivers is required to provide policy-relevant insights to predict utilisation and assist transfusion services with planning in light of the NHI rollout.